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| Item category | Item no. | Abbreviated item description | Therapeutic exercise detail |
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| What: materials | 1 | Type of exercise equipment | At the exercise program, treadmill and bicycle ergometer, rowing ergometer, and commercial weight machine were used |
| Who: provider | 2 | Qualifications, teaching/supervising expertise, and/or training of the exercise instructor | All training sessions were conducted in groups of 6 patients in a fitness gym of the Laboratory of Sports Medicine in Aristotle University of Thessaloniki. Exercise was implemented by a certified cardiac rehabilitation specialist under the supervision of a cardiologist |
| How: delivery | 3 | Whether exercises are performed individually or in a group | The rehabilitation session consisted of a group of 6 persons, and the exercised patients received 3 sessions/week, for a total duration of 1 hour |
| 4 | Whether exercises are supervised or unsupervised | All sessions were conducted in an outpatient rehabilitation center, in the fitness gym of the Laboratory of Sports Medicine under the instructions of a cardiac rehabilitation specialist and the supervision of a cardiologist |
| 5 | Measurement and reporting of adherence to exercise | Exercise adherence was recorded by the exercise trainer at every supervised session and was calculated by dividing the number of rehabilitation sessions attended by the number of rehabilitation sessions scheduled |
| 6 | Details of motivation strategies | The motivational program consisted of extensive counseling and information to ensure that patients received clear instructions, emphasizing the importance of regular and consistent exercise. Reinforcement techniques were used, with the physical training instructor giving positive feedback and commending patients for their efforts |
| 7 | Decision rules for progressing the exercise program | The exercise routine consisted of 10 minutes warm-up of upper and lower extremities with stretching and respiratory thoracic expansion exercises to prepare the musculoskeletal system. The first goal was a light to moderate aerobic training of 20-minute interval cycling on a bicycle ergometer or walking on a treadmill that corresponded to 60%-80% of the heart rate reached at peak oxygen uptake, as the strength training performed in a workload of 20-60% of 1 RM for 2-3 sets of 8-12 repetitions of a given exercise. Training intensity was increased gradually with respect to the individual’s tolerability and physiological adaptations. The last part of each session consisted of 5-10 minutes of stretching exercises for the large muscle-joint group |
| 8 | Each exercise is described so that it can be replicated (e.g., illustrations and photographs) | The warm-up took place in a sitting position; the aerobic exercise was performed on a cycle ergometer, treadmill, elliptical ergometer, rowing ergometer, or a combination; and dynamic strength exercises consisted of shoulder press, bicep curl, triceps extension, leg flexion-extension, leg extension, leg press, chest press, and seated row |
| 9 | Content of any home program component | All exercised patients were encouraged to increase their daily physical activity level on the nontraining days and be physically active |
| 10 | Nonexercise components | The intervention did not contain any specific education session, except for instructors’ support and advise for the health benefits of exercise to increase the adherence of the patients |
| Where: location | 11 | Setting in which exercises are performed | The 9-month intervention period consisted of a 6-month structured exercise protocol performed in a nonhospital environment and a 3-month postexercise training termination, while patients were advised to continue their active lifestyle and to refrain from any kind of supervised structured physical training program. Their daily physical activity was assessed by self-reporting personalized daily physical activity diaries |
| When, how much: dosage | 12 | Detailed description of the exercises (e.g., sets, repetitions, duration, and intensity) | Total duration of the exercise training protocol: 24 weeks
Frequency of sessions: 3 sessions/week
Total duration of session: 45-60 min
Warm-up: 10 min
Main part: 30-40 min, interval aerobic training for 20 min and 20 min strength training with 2-3 sets of 8-10 repetitions (20-60% of 1 RM).
Last part: 5-10 minutes of stretching exercises for the large muscle-joint group |
| Tailoring: what, how | 13 | Whether exercises are generic (“one size fits all”) or tailored to the individual | The exercise prescription was individualized and in accordance with the ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension and the American College of Sports Medicine (ACSM) recommendations for developing and maintaining cardiorespiratory fitness. The exercise program was tailored to the individual, depending on the pathogenesis and severity of pulmonary hypertension. The intensity of the exercise began at 60–80% of the maximal heart rate and workload of 20-60% of 1 RM for all individuals and was gradually increased depending on the subject’s response and adaptation to the exercise |
| 14 | Decision rule that determines the starting level for exercise | The exercise protocol was structured in accordance to ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by: Association for European Pediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT), and the American College of Sports Medicine (ACSM) recommendations for heart failure rehabilitation |
| How well: planned, actual | 15 | Whether the exercise intervention is delivered and performed as planned | Before each training session, the cardiac rehabilitation specialist described the planned exercise intervention to reach the desirable goal. The exercise intervention was delivered and performed as planned |
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