Exercise Intervention to Support Recovery After Allogeneic Stem Cell Transplantation in Adults With Myeloid Blood Disorders

Global cognitive function is assessed using the Montreal Cognitive Assessment (MoCA). The total score ranges from 0 to 30, with higher scores indicating better global cognitive function.

Reaction time is assessed using the OORTT 4 Positions Reaction Times and reported in milliseconds (ms). Lower values indicate faster responses.

Inhibitory control is assessed using the Flanker Task. The primary task-specific outcome is the reaction-time-based flanker interference effect, calculated as the difference in mean reaction time between incongruent and congruent trials and expressed in milliseconds (ms). A smaller interference effect indicates better inhibitory control. Reaction time and error rate are additionally recorded as task performance parameters.

Cognitive flexibility and task switching are assessed using Trail Making Test Part B. The outcome is completion time in seconds, with shorter completion times indicating better performance.

Working memory is assessed using Digit Span Backward. The outcome is the total score according to the standardized scoring procedure, with higher scores indicating better working-memory performance.

Static balance is assessed using the 4-Stage Balance Test, consisting of four progressively more difficult standing positions. Each position is held for up to 10 seconds. The outcome is the highest stage successfully maintained for 10 seconds, ranging from 0 to 4, with higher values indicating better static balance.

Maximum isometric handgrip strength is assessed using the CITEC Handheld Dynamometer Advanced Kit and expressed as peak force in Newtons (N). Three valid maximal trials are performed with the dominant hand, and the highest peak force is used for analysis. Higher values indicate greater handgrip strength.

Isometric knee flexor strength is assessed using the CITEC Handheld Dynamometer Advanced Kit and expressed as peak force in Newtons (N). Three valid maximal isometric knee extension trials are performed with the dominant leg, and the mean peak force of the three trials is used for analysis. Higher values indicate greater knee extensor strength.

Functional lower-extremity performance is assessed using the 30-Second Sit-to-Stand Test. The outcome is the number of complete sit-to-stand repetitions performed within 30 seconds. Higher values indicate better functional performance.

Exercise capacity is assessed using the Steep Ramp Test performed on a cycle ergometer. The outcome is peak work rate (WRpeak), expressed in watts (W), achieved at the end of the test. Higher values indicate greater exercise capacity.

Perceived cognitive impairment is assessed using the Perceived Cognitive Impairments (PCI) subscale of the Functional Assessment of Cancer Therapy-Cognitive Function, Version 3 (FACT-Cog v3). The PCI score ranges from 0 to 72, with higher scores indicating better self-reported cognitive function and fewer perceived cognitive impairments.

Global health status and quality of life are assessed using the Global Health Status/Quality of Life scale of the EORTC QLQ-C30. Scores are transformed to a scale from 0 to 100 according to the EORTC scoring manual, with higher scores indicating better global health status and quality of life.

General self-efficacy is assessed using the Allgemeine Selbstwirksamkeit Kurzskala (ASKU). The mean score ranges from 1 to 5, with higher scores indicating greater general self-efficacy.

Depressive symptoms are assessed using the 9-item Patient Health Questionnaire (PHQ-9). Total scores range from 0 to 27, with higher scores indicating greater depressive symptom severity.

Symptoms and treatment-related adverse effects are assessed using pre-specified items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Selected symptom attributes, including frequency, severity, and interference with daily activities, are analyzed at the item level according to the respective PRO-CTCAE response scales. Each attribute is scored from 0 to 4, with higher scores indicating greater symptom frequency, severity, or interference and therefore a worse outcome. No overall summary score is calculated.

Leisure-time physical activity is assessed using the Godin Leisure-Time Exercise Questionnaire. The primary metric is the Leisure Score Index, calculated as (9 × weekly frequency of strenuous activity) + (5 × weekly frequency of moderate activity) + (3 × weekly frequency of mild activity). The Leisure Score Index has a minimum value of 0 and no predefined maximum value because the reported weekly activity frequencies are not capped. Higher scores indicate greater leisure-time physical activity and therefore a better outcome.

Sedentary behavior is assessed using selected sitting-time items from the International Physical Activity Questionnaire (IPAQ). The outcome is average daily sitting time, expressed in minutes per day, with a theoretical range from 0 to 1,440 minutes per day. Higher values indicate more time spent sitting and therefore a worse outcome.

Reintegration is assessed using the study-specific RESTART Reintegration Questionnaire following allogeneic hematopoietic stem cell transplantation (HSCT). Items on return to everyday life, social integration, and ability to manage important daily activities are rated from 1 ("not at all") to 5 ("completely"); higher scores indicate better reintegration. Reintegration into employment, education, studies, or a comparable regular activity is rated from 1 to 5, with higher scores indicating better reintegration; 0 indicates "not applicable" and is not interpreted as a lower score. Current employment/education status is assessed categorically. An open-ended item assesses factors facilitating or hindering reintegration. Items are analyzed separately; no overall summary score is calculated.

Acute and/or chronic graft-versus-host disease (GvHD) is obtained from routine clinical records. GvHD status at hospital discharge and occurrence or progression during follow-up are documented, including clinically assessed grade or stage where applicable.

Clinically documented infections occurring after hospital discharge are obtained from routine clinical records. The number of infections per participant is recorded and infections are additionally characterized by type and severity.

The number of rehospitalizations occurring after hospital discharge is obtained from routine clinical records. Duration and reason for rehospitalization are additionally documented.