The Effectiveness of an Exergame-based Intervention

Maximum oxygen consumption will be obtained during a cardiopulmonary exercise test on a bicycle ergometer using a validated metabolic cart.

Pulse wave velocity will be obtained non-invasively using a clinically validated device for hemodynamic measurements. After a 10 min supine rest, a minimum of two readings will be performed on the right upper arm using customized arm cuffs.

Systolic blood pressure will be obtained non-invasively using a clinically validated device for hemodynamic measurements. After a 10 min supine rest, a minimum of two readings will be performed on the right upper arm using customized arm cuffs.

Diastolic blood pressure will be obtained non-invasively using a clinically validated device for hemodynamic measurements. After a 10 min supine rest, a minimum of two readings will be performed on the right upper arm using customized arm cuffs.

The sagittal curvature angle of the lumbar spine will be used to assess lumbar spine posture during lifting. It will be derived from kinematic recordings obtained using a skin marker-based motion capture system during standardized box-lifting tasks. Higher values will indicate greater lumbar flexion, reflecting a more rounded lumbar posture, whereas lower values will indicate a more upright or extended lumbar posture. Changes from baseline will be used to evaluate adaptations in lumbar movement strategy during lifting.

The Stoop-Squat Index will be used to quantify the relative contribution of trunk and knee motion during lifting, positioning the lifting strategy along a continuum from stoop-dominant to squat-dominant movement patterns. It will be calculated from kinematic data obtained using a skin marker-based motion capture system during standardized box-lifting tasks. Higher values will indicate a more stoop-dominant lifting strategy, characterized by greater trunk flexion and less knee flexion, whereas lower values will reflect a more squat-dominant lifting strategy. Changes from baseline will be used to evaluate adaptations in lifting technique.

The PHODA-SeV will be used to assess task-specific pain-related fear. This validated, image-based questionnaire presents participants with 40 daily activities, which they will rate in terms of perceived harmfulness using a numerical rating scale from 0 to 100. A score of 0 will indicate "not harmful," and a score of 100 will indicate "extremely harmful." Higher scores will indicate greater perceived threat or fear associated with specific activities, whereas lower scores will indicate less task-specific pain-related fear. Changes from baseline will be used to evaluate changes in task-specific pain-related fear.

The Tampa Scale of Kinesiophobia will be used to assess general fear of movement and fear of pain-related injury or reinjury. The 17-item version of the questionnaire will be administered, with each item rated on a 4-point Likert scale. Item scores will be summed to calculate a total score ranging from 17 to 68. Higher scores will indicate greater pain-related fear, whereas lower scores will indicate less pain-related fear. Changes from baseline will be used to evaluate changes in general pain-related fear.

Body mass index (BMI) will be assessed as a measure of body mass relative to height. Body mass (in kilogramm) will be measured using a calibrated scale with participants wearing light clothing and no shoes. Height (in meters) will be measured using a stadiometer with participants standing upright without shoes. BMI will be calculated as body mass in kilograms divided by height in meters squared (kg/m²).