Hybrid Exercise Training for Health, Performance and Well-Being (DoIT II)

Change in body mass

Body mass (kg) will be measured using a beam scale

Time frame: At baseline, at 6 months and at 12 months

Change in body mass index

Body mass index will be calculated using the Quetelet's equation

Time frame: At baseline, at 6 months and at 12 months

Change in waist circumference

Waist circumference (cm) will be measured using a Gullick II tape

Time frame: At baseline, at 6 months and at 12 months

Change in hip circumference

Hip circumference (cm) will be measured using a Gullick II tape

Time frame: At baseline, at 6 months and at 12 months

Change in waist-to-hip ratio

Waist-to-hip ratio will be calculated by dividing the waist by the hip measurement

Time frame: At baseline, at 6 months and at 12 months

Change in body fat

Body fat (%) will be assessed by whole-body dual-energy X-ray absorptiometry (DXA)

Time frame: At baseline and at 12 months

Change in fat mass

Body fat (kg) will be assessed by whole-body dual-energy X-ray absorptiometry (DXA)

Time frame: At baseline and at 12 months

Change in fat-free mass

Fat-free mass (kg) will be assessed by whole-body dual-energy X-ray absorptiometry (DXA)

Time frame: At baseline and at 12 months

Change in resting metabolic rate (RMR)

RMR (kcal) will be measured using a portable open-circuit indirect calorimeter with a ventilated hood system

Time frame: At baseline, at 6 months and at 12 months

Change in maximal strength (1RM)

1RM (kg) for the lower body will be measured bilaterally on a horizontal leg press, seated leg extension and lying leg curl machines while 1RM (kg) for the upper body will be measured on a seated chest press and lat pull-down machines

Time frame: At baseline, at 6 months and at 12 months

Change in maximal oxygen consumption (VO2max)

VO2max (ml/kg/min) will be estimated using a low-risk, low-cost and single-stage submaximal treadmill walking test

Time frame: At baseline, at 6 months and at 12 months

Change in habitual physical activity (PA)

Seven-day habitual PA (MET-min/week) will be assessed using the International Physical Activity Questionnaire (IPAQ)

Time frame: At baseline, at 3, 6, 9 and 12 months

Change in dietary intake

Dietary intake (kcal) will be assessed using 7-day diet recalls

Time frame: At baseline, at 3, 6, 9 and 12 months

Change in body mass content (BMC)

BMC (g) will be assessed by dual-energy X-ray absorptiometry (DXA) of the total body and non-dominant hip.

Time frame: At baseline and at 12 months

Change in body mass density (BMD)

BMD (g) will be assessed by dual-energy X-ray absorptiometry (DXA) of the total body and non-dominant hip.

Time frame: At baseline and at 12 months

Change in resting systolic (SBP) and diastolic (DBP) blood pressures.

Resting SBP (mmHg) and DBP (mmHg) will be assessed by a manual sphygmomanometer

Time frame: At baseline, at 6 months and at 12 months

Change in mean arterial pressure (MAP).

MAP (mmHg) will be calculated using the following equation: MAP = SBP + (DBP × DBP) / 3

Time frame: At baseline, at 6 months and at 12 months

Change in resting heart rate (RHR).

RHR (bpm) will be measured by pulse palpation for 60 seconds.

Time frame: At baseline, at 6 months and at 12 months

Change in muscular endurance

Muscular endurance (repetitions until muscle failure) will be assessed using timed tests (60 sec) for the abdominal musculature, upper and lower body. The tests will include partial curl-up, push-up for males and modified push-up for females (kneeling position) and modified chair squat, respectively

Time frame: At baseline, at 6 months and at 12 months

Change in flexibility

Flexibility (cm) will be assessed using the modified sit-and-reach test

Time frame: At baseline, at 6 months and at 12 months

Change in static balance

Static balance (sec) will be assessed using the Sharpened Romberg test

Time frame: At baseline, at 6 months and at 12 months

Change in functional capacity

Functional capacity will be assessed using a movement-based screening tool titled Functional Movement Screening (FMS). The FMS will be consisted of 7 movement tasks that will be scored from 0 to 3 points and the sum will create score ranging from 0 to 21 points (0 = pain with pattern regardless of quality, 1 = unable to perform pattern, 2 = able to perform pattern with compensation/imperfection, 3 = able to perform pattern as directed).

Time frame: At baseline, at 6 months and at 12 months

Change in blood lipids

Total serum cholesterol (mmol/L), triglycerides (mmol/L), low-density lipoprotein (mmol/L) and high-density lipoprotein (mmol/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in blood inflammatory markers

Cytokines, lipocalines, CRP, oxidative stress markers will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in cortisol

Cortisol (nmol/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in insulin

Insulin (mIU/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in homeostatic model assessment for insulin resistance (HOMA-IR)

HOMA-IR will be measured with commercially availlable kits. ΗΟΜΑ score will be calculated using the equation HOMA-IR = fasting insulin (mIU/L) x fasting glucose (mg/dL) / 405. HOMA-IR score will be classified using the following range: normal insulin resistance \< 3, moderate insulin resistance 3-5, severe insulin resistance \> 5)

Time frame: At baseline and at 12 months

Change in leptin

Leptin (μg/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in adiponectin

Adiponectin (μg/mL) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in interleukin 1 beta (IL-1b) and interleuking 6 (IL-6)

IL-1b and IL-6 (pg/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in fasting blood glucose (FBG)

FBG (mg/dL) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in serum protein carbonyl levels

Protein carbonyl (mg) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in thiobarbituric acid-reactive substances (TBARS)

TBARS (nmol/mg protein) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in reduced (GSH) and oxidized (GSSG) glutathione

GSH and GSSG (nmol/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in catalase activity

Catalase activity (units) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in total antioxidant capacity (TAC)

TAC (mmol/l) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in C-reactive protein (CRP)

CRP (mg/L) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in cholecystokinin (CKK)

CKK (ng/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in pancreatic polypeptide (PP)

PP (pg/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in peptide YY (PYY)

PYY (ng/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in oxyntomodulin (OXM)

OXM (pg/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in ghrelin

Ghrelin (pg/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in glucagon-like peptide-1 (GLP-1)

GLP-1 (pg/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in appetite

The Visual Analog Scale (VAS) will be used to measure perceived hunger, satiety, and individual's own interpretation of their hunger sensations. VAS is a straight horizontal line of fixed length, usually 100 mm. The ends are defined as the extreme limits of the parameter to be measured orientated from the left (worst) to the right (best).

Time frame: At baseline, at 6 months and at 12 months

Change in quality of life

Quality of life will be assessed using the physical and mental component subscales of the Greek 36-Item Short-Form Health Survey (SF-36). The scores on both component subscales of the SF-36 will range from 0 to 100, with higher scores indicating better health status while the minimal clinically important difference will be 2 points.

Time frame: At baseline, at 6 months and at 12 months

Change in exercise enjoyment

Exercise enjoyment will be assessed using the Exercise Enjoyment Scale (EES), which is a single-item 7-point scale to assess enjoyment pre-, during, and post-exercise ranging from "not at all" at 1 to "extremely" at 7.

Time frame: At baseline, at 6 months and at 12 months

Change in affective valence

Affective responses to exercise will be assessed using the Feeling Scale (FS), which is a single-item 11-point scale to assess feeling of pleasure pre-, during, and post-exercise training ranging from "very good" at -5 to "very bad" at 5.

Time frame: At baseline, at 6 months and at 12 months

Change in irisin

Irisin (ng/ml) will be measured with commercially availlable kits

Time frame: At baseline and at 12 months

Change in left ventricular end-diastolic volume (LVEDV).

LVEDV (ml) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular end-systolic volume (LVESV).

LVESV (ml) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular stroke volume (LVSV).

LVSV (ml) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in interventricular septum end diastole (IVSd).

IVSd (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in interventricular septum end diastole (IVSs).

IVSs (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular ejection fraction (LVEF).

LVEF (%) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular internal diameter end diastole (LVIDd).

LVIDd (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular internal diameter end systole (LVIDs).

LVIDs (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular posterior wall end diastole (LVPWd).

LVPWd (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular mass (LV mass).

LV mass (g) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left atrial (LA) diameter.

LA diameter (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in aortic root.

Aortic root (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in aortic valve velocity (AoV Vel).

AoV Vel (cm/s) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in aortic valve pressure gradient (AoV PG).

AoV PG (mmHg) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in right ventricular end diastole (RVD).

RVD (mm) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in pulmonary artery systolic pressure (PASP).

PASP (mmHg) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in left ventricular fractional shortening (FS).

Fractional shortening (%) will be measured using echocardiography.

Time frame: At baseline and at 12 months

Change in depression II.

Depression will be measured using the Patient Health Questionnaire (PHQ-9)), which is a self-administered instrument consisiting of 9 multiple-choice questions scored from 0 to 3. Higher total scores indicate higher depression severity.

Time frame: At baseline, at 6 months and at 12 months

Change in depression I.

Depression will be measured using the Beck Depression Inventory (BDI), which is a self-report questionnaire consisiting of 21 multiple-choice questions scored from 0 to 3. Higher total scores indicate more severe depressive symptoms.

Time frame: At baseline, at 6 months and at 12 months

Change in depression and anxiety.

Both depression and anxiety will be measured using the Hospital Anxiety and Depression Scale (HADS), which is a 14-item scale that generates ordinal data. Seven of the items relate to anxiety and seven relate to depression. Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression. Higher scores indicate greater anxiety and depression.

Time frame: At baseline, at 6 months and at 12 months

Change in mood.

Mood will be measured using the Profile of Mood States (POMS) questionnaire, which uses a unipolar scale to rate the extent to which they are experiencing or have experienced 20 affect states in the past week using a 5-point scale (0 = not at all, 4 = extremely). Higher scores indicate greater negative mood.

Time frame: At baseline, at 6 months and at 12 months

Change in anxiety.

Anxiety will be measured using the State-Trait Anxiety Inventory (STAI), which is an instrument that has 20 items for assessing trait anxiety and 20 for state anxiety. All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always"). Higher scores indicate greater anxiety.

Time frame: At baseline, at 6 months and at 12 months

Change in physical self.

Physical self will be measured using the Physical Self-Perception Profile (PSPP), which is an instrument with 30 questions comprising five 6-item subscales. Each item has a four-point structured-alternative format. Scores range from 6 to 24 on each subscale, with high scores representing positive perceptions. Half of the items are worded in the negative direction.

Time frame: At baseline, at 6 months and at 12 months