Leg extension

Resistance training was performed three times per week for 8 weeks at 80% of 1 repetition maximum (1RM) on the knee extensor complex. Exercises included the back squat, leg press, leg extension (Technogym, Berkshire, United Kingdom), lunge, Bulgarian split squat and Sampson chair. All exercise sessions were supervised by a member of the research team. Participants completed two familiarization sessions at 70%1RM prior to commencing the RT program. 1RMs were measured at baseline and every 2 weeks, with loading weight progressed. Each training session consisted of four exercises with participants performing three sets of 10 repetitions per exercise for the first 4 weeks, and four sets of eight repetitions per exercise thereafter. Training records were diligently completed during sessions. Following RT, participants returned to habitual daily activities with no form of exercise training permitted for the detraining period (4 weeks).

Resistance training (RT) was performed three times per week for 8 weeks at 80% of 1 repetition maximum (1RM) on the knee extensor complex. Exercises included the back squat, leg press, leg extension (Technogym, Berkshire, UK), lunge, Bulgarian split squat and Sampson chair. All exercise sessions were supervised by a member of the research team. Participants completed two familiarisation sessions at 70%1RM prior to commencing the resistance training program. 1RMs were measured at baseline and every 2 weeks, with loading weight progressed. Volume (i.e. repetitions and sets) was identical for each training group, with each training session consisting of four exercises and performing three sets of 10 repetitions per exercise for the first 4 weeks, and four sets of eight repetitions per exercise thereafter. Training sessions would typically last ~60 minutes, with training records being diligently completed during sessions.

Training sessions at the hospital gym were carried out following the indication of American College of Sports Medicine [28] . Training program included 3 training sessions per week of 90 min duration. Each training session begun with 10 min of a mix of warm up, and was followed by a 45-minute endurance training: 5 min of low-intensity warm up; 35 min of continuous moderate-intensity training (corresponding to 60–80% of VO2 peak registered during CPET); 5 min of low intensity cool down. Endurance training was carried out with the use of cardio machines, such as cycle ergometer and treadmill (Technogym, Rotterdam). Aerobic exercise was followed by 20 min of resistance strength training, conducted at a variable load of 30–50% of the 1-RM, with the use of compressed-air isotonic machines (pectoral machine, lower-back, leg press, leg extension, adductor machine, deltoids press; Technogym, Rotterdam). At the end of the training session, 5 min of stretching activities were performed. Patient safety during training was ensured by strict monitoring peripheral arterial oxygen saturation, blood pressure and telemetric electrocardiogram.