Exercise With Individual Dosage Against the Best Current Practice in Lower Limb Tendinopathy (MaLaGa Trial)

Study Overview
=================
Brief Summary
-----------------
This study compares the effect of a therapeutic physical exercise programme based on an individualized control of the exercise dose by monitoring the force-speed curves against the current best practice in the treatment of tendinopathies of the lower limb. Half of the participants will receive the experimental intervention, while the other half will receive the best current practice.

Detailed Description
-----------------
The current best practice is based on a progressive strength training sustained in the continuous model of tendinopathy proposed by Cook and Purdam (Cook & Purdam, 2009), showing in the literature this methodology more effective than the wait and see approach or that the use of corticosteroid injections, accentuating the differences in long-term follow-up evaluations (Mellor et al., 2018). However, the current system lacks an objectification methodology for the severity of the pathology and objective criteria for the progression of the load, usually based on subjective feelings of discomfort or pre-established intensities. Therefore, the investigators hypothesize that the development and introduction of a methodology for the quantification and progression of the loads, with an individual control and management of the exercise dose, as well as the execution of specific exercises for each one of them, could improve the clinica and functional results. Moreover, achieving neuromuscular adaptations based on the characteristics of the neuromuscular system, could improve the times and results of the intervention, as well as the rate of treatment failures, in the tendinopathies of the lower limbs.

Official Title
-----------------
Effect of a Common Exercise Programme With an Individualized Progression Criterion Based on the Measurement of Neuromuscular Capacity Versus Eccentric Training for Lower Limb Tendinopathies (MaLaGa Trial): Randomised Clinical Trial

Conditions
-----------------
Tendinopathy

Intervention / Treatment
-----------------
* Other: Best current practice exercise programme
* Other: Experimental exercise programme


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: People between 18 and 65 years with a clinical diagnosis of mid-portion Achilles, patellar, or gluteal tendinopathy; Pain duration for at least one month. Exclusion Criteria: Corticosteroid injection in the studied tendon in the last 12 months; Other injuries in the affected lower limb in the last 12 months; Previous surgery for musculoskeletal causes of the affected lower limb in the last 12 months; Tendinous rupture history in the affected lower limb; Systemic diseases such as rheumatic arthritis or diabetes mellitus.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled trial, with two parallel groups (control and intervention)
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Best current practice exercise programme<br>Therapeutic physical exercise, best current practice: Achilles tendinopathy: ALFREDSON ECCENTRIC PROTOCOL: two exercises performed eccentrically, twice daily, 7 days/week, 14 weeks (6 weeks are added to the program to match the volume of weeks of the experimental group). Patellar tendinopathy: ALFREDSON ECCENTRIC PROTOCOL: one exercise performed eccentrically, twice daily, 7 days/week, 14 weeks (6 weeks are added to the program to match the volume of weeks of the experimental group). Gluteal Tendinopathy: EXERCISE LEAP PROTOCOL, from daily to twice weekly, 14 weeks (6 weeks are added to the program to match the volume of weeks of the experimental group). | Other: Best current practice exercise programme<br>* Therapeutic Physical Exercise programme based on the protocol of Afredson (for Achilles and patellar tendinopathies) and LEAP (for gluteal tendinopathy). Achilles tendinopathy: ALFREDSON ECCENTRIC PROTOCOL: 3 sets of 15 repetitions of two eccentric exercises Patellar tendinopathy: ALFREDSON ECCENTRIC PROTOCOL: 3 sets of 15 repetions of one eccentric exercise Gluteal Tendinopathy: EXERCISE LEAP PROTOCOL: an exercise programme divided into stages with progression in different exercises, volumes and loads<br>* Other names: LEAP protocol;|
| Experimental: Experimental exercise programme<br>Therapeutic physical exercise common for the three locations (Achilles, patellar and gluteal tendinopathy), based on an individual dosage and neuromuscular adaptations (five stages): Strength training four exercises, once daily, three times/week, 14 weeks Aerobic training: Once daily, twice weekly | Other: Experimental exercise programme<br>* Therapeutic Physical Exercise programme structured in five stages oriented to specific neuromuscular adaptations based on the characteristics of the neuromuscular system, once daily, three times/week, sets, repetitions and load based on individually performed tests.<br>* Other names: MaLaGa protocol;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Victorian Institute of Sport Assessment (VISA) questionnaire POST | Visa-A for Achilles tendon, Visa-P for Patellar tendon, Visa-G for Gluteal tendon: functional mobility, life participation, and pain. Assessed from 0 (worst value) to 100 (best value). | Post, 14 weeks after start of the intervention (when intervention is finished) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Victorian Institute of Sport Assessment (VISA) questionnaire PRE | Visa-A model for Achilles tendon, Visa-P model for Patellar tendon, Visa-G model for Gluteal tendon: functional mobility, life participation, and pain. Assessed from 0 (worst value) to 100 (best value). | Baseline, 1 week before start of the intervention | 
| Victorian Institute of Sport Assessment (VISA) questionnaire SHOR TERM | Visa-A for Achilles tendon, Visa-P for Patellar tendon, Visa-G for Gluteal tendon: functional mobility, life participation, and pain. Assessed from 0 (worst value) to 100 (best value). | Short term, 7 weeks after start of the intervention | 
| Victorian Institute of Sport Assessment (VISA) questionnaire Follow-up | Visa-A for Achilles tendon, Visa-P for Patellar tendon, Visa-G for Gluteal tendon: functional mobility, life participation, and pain. Assessed from 0 (worst value) to 100 (best value). | 52 weeks after the start of the intervention | 
| Central Sensitization Inventory (CSI) PRE | Questionnaire to help identify patients with Central Sensitivity Syndromes. Range 0-100. Five severity levels developed to help aid in the clinical interpretation of the CSI (subclinical = 0-29; mild = 30-39; moderate = 40-49; severe = 50-59; and extreme = 60-100) | Baseline, 1 week before start of the intervention | 
| Central Sensitization Inventory (CSI) SHORT TERM | Questionnaire to help identify patients with Central Sensitivity Syndromes. Range 0-100. Five severity levels developed to help aid in the clinical interpretation of the CSI (subclinical = 0-29; mild = 30-39; moderate = 40-49; severe = 50-59; and extreme = 60-100) | Short term, 7 weeks after start of the intervention | 
| Central Sensitization Inventory (CSI) POST | Questionnaire to help identify patients with Central Sensitivity Syndromes. Range 0-100. Five severity levels developed to help aid in the clinical interpretation of the CSI (subclinical = 0-29; mild = 30-39; moderate = 40-49; severe = 50-59; and extreme = 60-100) | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Central Sensitization Inventory (CSI) FOLLOW-UP | Questionnaire to help identify patients with Central Sensitivity Syndromes. Range 0-100. Five severity levels developed to help aid in the clinical interpretation of the CSI (subclinical = 0-29; mild = 30-39; moderate = 40-49; severe = 50-59; and extreme = 60-100) | 52 weeks after start of the intervention | 
| Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) PRE | OMPSQ is a self-administered pain screening questionnaire applied to identify patients with acute or subacute musculoskeletal pain who are at risk of delayed recovery. A higher score indicates a higher disability. The maximum score is 210 points; a score of < 105 points indicates a low disability, that between 105 and 130 points indicates a moderate disability and that > 130 points indicates a high disability | Baseline, 1 week before start of the intervention | 
| Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) SHORT TERM | OMPSQ is a self-administered pain screening questionnaire applied to identify patients with acute or subacute musculoskeletal pain who are at risk of delayed recovery. A higher score indicates a higher disability. The maximum score is 210 points; a score of < 105 points indicates a low disability, that between 105 and 130 points indicates a moderate disability and that > 130 points indicates a high disability | Short term, 7 weeks after start of the intervention | 
| Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) POST | OMPSQ is a self-administered pain screening questionnaire applied to identify patients with acute or subacute musculoskeletal pain who are at risk of delayed recovery. A higher score indicates a higher disability. The maximum score is 210 points; a score of < 105 points indicates a low disability, that between 105 and 130 points indicates a moderate disability and that > 130 points indicates a high disability | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) FOLLOW-UP | OMPSQ is a self-administered pain screening questionnaire applied to identify patients with acute or subacute musculoskeletal pain who are at risk of delayed recovery. A higher score indicates a higher disability. The maximum score is 210 points; a score of < 105 points indicates a low disability, that between 105 and 130 points indicates a moderate disability and that > 130 points indicates a high disability | 52 weeks after start of the intervention | 
| Fear Avoidance Components Scale (FACS) PRE | The FACS scale comprehensively assesses the presence of fear avoidance beliefs and attitudes in people with painful medical conditions. The FACS instructions ask participants to reflect on past painful experiences, and to indicate the degree to which these experiences influence on their activity. There are 20 thoughts or feelings related to avoidance, on 6-point scales with the end points (0) completely disagree and (5) completely agree. The FACS yields a total score between 0, best score, and 100, worst score. | Baseline, 1 week before start of the intervention | 
| Fear Avoidance Components Scale (FACS) SHORT TERM | The FACS scale comprehensively assesses the presence of fear avoidance beliefs and attitudes in people with painful medical conditions. The FACS instructions ask participants to reflect on past painful experiences, and to indicate the degree to which these experiences influence on their activity. There are 20 thoughts or feelings related to avoidance, on 6-point scales with the end points (0) completely disagree and (5) completely agree. The FACS yields a total score between 0, best score, and 100, worst score. | Short term, 7 weeks after start of the intervention | 
| Fear Avoidance Components Scale (FACS) POST | The FACS scale comprehensively assesses the presence of fear avoidance beliefs and attitudes in people with painful medical conditions. The FACS instructions ask participants to reflect on past painful experiences, and to indicate the degree to which these experiences influence on their activity. There are 20 thoughts or feelings related to avoidance, on 6-point scales with the end points (0) completely disagree and (5) completely agree. The FACS yields a total score between 0, best score, and 100, worst score. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Fear Avoidance Components Scale (FACS) FOLLOW-UP | The FACS scale comprehensively assesses the presence of fear avoidance beliefs and attitudes in people with painful medical conditions. The FACS instructions ask participants to reflect on past painful experiences, and to indicate the degree to which these experiences influence on their activity. There are 20 thoughts or feelings related to avoidance, on 6-point scales with the end points (0) completely disagree and (5) completely agree. The FACS yields a total score between 0, best score, and 100, worst score. | 52 weeks after start of the intervention | 
| European Quality of Life-5 Dimensions (EQ-5D) PRE | EQ-5D is a standardized instrument for measuring generic health status. The EQ-5D questionnaire has two components: health state description and evaluation. In the description part, health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the person's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in work, study, housework, family or leisure activities. In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are. Each dimension is rated in 5 levels from I have no problem with... to I am unable to... | Baseline, 1 week before start of the intervention | 
| European Quality of Life-5 Dimensions (EQ-5D) SHORT TERM | EQ-5D is a standardized instrument for measuring generic health status. The EQ-5D questionnaire has two components: health state description and evaluation. In the description part, health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the person's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in work, study, housework, family or leisure activities. In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are. Each dimension is rated in 5 levels from I have no problem with... to I am unable to... | Short term, 7 weeks after start of the intervention | 
| European Quality of Life-5 Dimensions (EQ-5D) POST | EQ-5D is a standardized instrument for measuring generic health status. The EQ-5D questionnaire has two components: health state description and evaluation. In the description part, health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the person's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in work, study, housework, family or leisure activities. In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are. Each dimension is rated in 5 levels from I have no problem with... to I am unable to... | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| European Quality of Life-5 Dimensions (EQ-5D) FOLLOW-UP | EQ-5D is a standardized instrument for measuring generic health status. The EQ-5D questionnaire has two components: health state description and evaluation. In the description part, health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Mobility dimension asks about the person's walking ability. Self-care dimension asks about the ability to wash or dress by oneself, and usual activities dimension measures performance in work, study, housework, family or leisure activities. In pain/discomfort dimension, it asks how much pain or discomfort they have, and in anxiety/depression dimension, it asks how anxious or depressed they are. Each dimension is rated in 5 levels from I have no problem with... to I am unable to... | 52 weeks after start of the intervention | 
| Lower Limb Functional Index (LLFI) PRE | The LLFI is an index designed for assessing the functional capacity of the lower limbs with a combination of constructs that includes body functions, body structures, activities and participation, and environmental factors. The LLFI has 25 phrases as items and participants have to select which ones they identify with. The final score is calculated with the following formula: 100 - (number of sentences chosen x 4). The LLFI yields a total score (between 100, best score, and 0, worst score). | Baseline, 1 week before start of the intervention | 
| Lower Limb Functional Index (LLFI) POST | The LLFI is an index designed for assessing the functional capacity of the lower limbs with a combination of constructs that includes body functions, body structures, activities and participation, and environmental factors. The LLFI has 25 phrases as items and participants have to select which ones they identify with. The final score is calculated with the following formula: 100 - (number of sentences chosen x 4). The LLFI yields a total score (between 100, best score, and 0, worst score). | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Lower Limb Functional Index (LLFI) SHORT TERM | The LLFI is an index designed for assessing the functional capacity of the lower limbs with a combination of constructs that includes body functions, body structures, activities and participation, and environmental factors. The LLFI has 25 phrases as items and participants have to select which ones they identify with. The final score is calculated with the following formula: 100 - (number of sentences chosen x 4). The LLFI yields a total score (between 100, best score, and 0, worst score). | Short term, 7 weeks after start of the intervention | 
| Lower Limb Functional Index (LLFI) FOLLOW-UP | The LLFI is an index designed for assessing the functional capacity of the lower limbs with a combination of constructs that includes body functions, body structures, activities and participation, and environmental factors. The LLFI has 25 phrases as items and participants have to select which ones they identify with. The final score is calculated with the following formula: 100 - (number of sentences chosen x 4). The LLFI yields a total score (between 100, best score, and 0, worst score). | 52 weeks after start of the intervention | 
| Lower limb Strength PRE | Assessment of the isometric strength in the leg press machine using a s-beam load cell | Short term, 7 weeks after start of the intervention | 
| Lower limb Strength SHORT TERM | Assessment of the isometric strength in the leg press machine using a s-beam load cell | Short term, 7 weeks after start of the intervention | 
| Lower limb Strength POST | Assessment of the isometric strength in the leg press machine using a s-beam load cell | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Lower limb Strength FOLLOW-UP | Assessment of the isometric strength in the leg press machine using a s-beam load cell | 52 weeks after start of the intervention | 
| Muscular Thickness PRE | Measurement of the muscular thickness (in cm) by Ultrasonography | Baseline, 1 week before start of the intervention | 
| Muscular Thickness SHORT TERM | Measurement of the muscular thickness (in cm) by Ultrasonography | Short term, 7 weeks after start of the intervention | 
| Muscular Thickness POST | Measurement of the muscular thickness (in cm) by Ultrasonography | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Muscular Thickness FOLLOW-UP | Measurement of the muscular thickness (in cm) by Ultrasonography | 52 weeks after start of the intervention | 
| Pressure Pain Threshold PRE | Measurement of the Pressure Pain Threshold of tendon with a hand-held algometer. The tester is placed perpendicular to the skin over the test area, increasing the pressure 30kPa/s. Participants are instructed to indicate when the sensation change from comfortable pressure to slightly unpleasant pain. Test is repeated three times with one minute of rest between repetitions. The mean value is used for the analysis. | Baseline, 1 week before start of the intervention | 
| Pressure Pain Threshold SHORT TERM | Measurement of the Pressure Pain Threshold of tendon with a hand-held algometer. The tester is placed perpendicular to the skin over the test area, increasing the pressure 30kPa/s. Participants are instructed to indicate when the sensation change from comfortable pressure to slightly unpleasant pain. Test is repeated three times with one minute of rest between repetitions. The mean value is used for the analysis. | Short term, 7 weeks after start of the intervention | 
| Pressure Pain Threshold POST | Measurement of the Pressure Pain Threshold of tendon with a hand-held algometer. The tester is placed perpendicular to the skin over the test area, increasing the pressure 30kPa/s. Participants are instructed to indicate when the sensation change from comfortable pressure to slightly unpleasant pain. Test is repeated three times with one minute of rest between repetitions. The mean value is used for the analysis. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Pressure Pain Threshold FOLLOW-UP | Measurement of the Pressure Pain Threshold of tendon with a hand-held algometer. The tester is placed perpendicular to the skin over the test area, increasing the pressure 30kPa/s. Participants are instructed to indicate when the sensation change from comfortable pressure to slightly unpleasant pain. Test is repeated three times with one minute of rest between repetitions. The mean value is used for the analysis. | 52 weeks after start of the intervention | 
| Pain at rest measured with Visual Analogue Scale (VAS) PRE | Measurement of the Pain at rest with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Baseline, 1 week before start of the intervention | 
| Pain at rest measured with Visual Analogue Scale (VAS) SHORT TERM | Measurement of the Pain at rest with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Short term, 7 weeks after start of the intervention | 
| Pain at rest measured with Visual Analogue Scale (VAS) POST | Measurement of the Pain at rest with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Pain at rest measured with Visual Analogue Scale (VAS) FOLLOW UP | Measurement of the Pain at rest with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | 52 weeks after start of the intervention | 
| Pain during activity (running) measured with Visual Analogue Scale (VAS) PRE | Measurement of the Pain during activity (running) with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Baseline, 1 week before start of the intervention | 
| Pain during activity (running) measured with Visual Analogue Scale (VAS) SHORT-TERM | Measurement of the Pain during activity (running) with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Short term, 7 weeks after start of the intervention | 
| Pain during activity (running) measured with Visual Analogue Scale (VAS) POST | Measurement of the Pain during activity (running) with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Pain during activity (running) measured with Visual Analogue Scale (VAS) FOLLOW UP | Measurement of the Pain during activity (running) with a 100 mm VAS scale, 0 being no pain and 100 being the worst imaginable pain | 52 weeks after start of the intervention | 
| Treatment satisfaction PRE | Treatment satisfaction assessed using a visual analog scale, from 0 to 100mm, with 0 being not at all satisfied and 10 being extremely satisfied. | Baseline, 1 week before start of the intervention | 
| Treatment satisfaction SHORT-TERM | Treatment satisfaction assessed using a visual analog scale, from 0 to 100mm, with 0 being not at all satisfied and 10 being extremely satisfied. | Short term, 7 weeks after start of the intervention | 
| Treatment satisfaction POST | Treatment satisfaction assessed using a visual analog scale, from 0 to 100mm, with 0 being not at all satisfied and 10 being extremely satisfied. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Treatment satisfaction FOLLOW UP | Treatment satisfaction assessed using a visual analog scale, from 0 to 100mm, with 0 being not at all satisfied and 10 being extremely satisfied. | 52 weeks after start of the intervention | 
| Lower limb Strength measured with hand-held dinamometer PRE | Lower limb Strength measured with hand-held dinamometer (ankle plantarflexion for Achilles tendinopathy, knee extension for patellar tendinopathy, and hip abduction for gluteal tendinopathy). Two repetitions are performed and the mean value is used for the analysis. | Baseline, 1 week before start of the intervention | 
| Lower limb Strength measured with hand-held dinamometer POST | Lower limb Strength measured with hand-held dinamometer (ankle plantarflexion for Achilles tendinopathy, knee extension for patellar tendinopathy, and hip abduction for gluteal tendinopathy). Two repetitions are performed and the mean value is used for the analysis. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Lower limb Strength measured with hand-held dinamometer SHORT TERM | Lower limb Strength measured with hand-held dinamometer (ankle plantarflexion for Achilles tendinopathy, knee extension for patellar tendinopathy, and hip abduction for gluteal tendinopathy). Two repetitions are performed and the mean value is used for the analysis. | Short term, 7 weeks after start of the intervention | 
| Lower limb Strength measured with hand-held dinamometer FOLLOW UP | Lower limb Strength measured with hand-held dinamometer (ankle plantarflexion for Achilles tendinopathy, knee extension for patellar tendinopathy, and hip abduction for gluteal tendinopathy). Two repetitions are performed and the mean value is used for the analysis. | 52 weeks after start of the intervention | 
| HDEMG profile with Non Invasive Surface High-Density Electromyography (HDEMG) PRE | Non invasive surface HDEMG during maximal isometric voluntary contraction performed in a leg press machine. Surface HDEMG is recorded during 20 seconds. Data obtained is analysed to extract the mean discharge rate of the motor units (in fires per second) and the recruitment and derecruitment threshold (in Nw). This variable will only be assessed in a randomly selected subgroup of each arm. | Baseline, 1 week before start of the intervention | 
| HDEMG profile with Non Invasive Surface High-Density Electromyography (HDEMG) POST | Non invasive surface HDEMG during maximal isometric voluntary contraction performed in a leg press machine. Surface HDEMG is recorded during 20 seconds. Data obtained is analysed to extract the mean discharge rate of the motor units (in fires per second) and the recruitment and derecruitment threshold (in Nw). This variable will only be assessed in a randomly selected subgroup of each arm. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Amount of physical activity with International Physical Activity Questionnaire Short Form (IPAQ-SF) | Amount of physical activity of the patients through seven questions about the physical activity performed the previous seven days. Physical activity can be interpreted as a numerical value (reported as median MET-minutes) and as low, moderate, or high activity levels. | Baseline, 1 week before start of the intervention | 
| Amount of physical activity with International Physical Activity Questionnaire Short Form (IPAQ-SF) | Amount of physical activity of the patients through seven questions about the physical activity performed the previous seven days. Physical activity can be interpreted as a numerical value (reported as median MET-minutes) and as low, moderate, or high activity levels. | Short term, 7 weeks after start of the intervention | 
| Amount of physical activity with International Physical Activity Questionnaire Short Form (IPAQ-SF) | Amount of physical activity of the patients through seven questions about the physical activity performed the previous seven days. Physical activity can be interpreted as a numerical value (reported as median MET-minutes) and as low, moderate, or high activity levels. | Post, 14 weeks after start of the intervention (when intervention is finished) | 
| Amount of physical activity with International Physical Activity Questionnaire Short Form (IPAQ-SF) | Amount of physical activity of the patients through seven questions about the physical activity performed the previous seven days. Physical activity can be interpreted as a numerical value (reported as median MET-minutes) and as low, moderate, or high activity levels. | 52 weeks after start of the intervention | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
tendinopathy, exercise, dosage, physiotherapy