Table 2

Description of themes, subthemes and quality ratings with examples

Theme	Subtheme	Description of rating	Examples of data supporting rating	Rating
Preparatory work	Need for the study	Multiple sources of evidence of need for the study, for example, recent systematic review, guidelines, high level reports, commissioned research, national audit	International task force highlighted lack of evidence and need for evaluation. Cochrane review drew similar conclusions.
		Single source of evidence/non-systematic review to support need for study	Old systematic review indicates paucity of high quality research.
		Lack of clarity or underpinning evidence regarding need for study	Poor justification for the study. Evidence cited does not support the need for this particular study.
	Theoretical underpinning	Theoretical underpinning described	Physiological and psychological theories underpinning the intervention described in detail.
		Lacks clear theoretical underpinning	No information provided regarding the theoretical basis for the intervention provided.
	Co-design	Good PPI and expert clinical input	Patients and clinicians helped develop the intervention.
		Good PPI but weak or no expert clinical input/Good clinical input but unclear or no PPI	Clinicians contributed to the intervention development but no indication of service user involvement.
		No co-design	No co-design was undertaken to develop the intervention.
	Contextual considerations	Context considered	The use of different professionals in delivering the intervention reflected the real-world situation of how this would occur in practice.
		Context not adequately considered	There was a lack of understanding of relevant context and factors needed for intervention development and delivery.
	Piloting of intervention	Pilot conducted, evaluated and findings addressed for main evaluation	The pilot data helped refine the intervention for evaluation in the main trial.
		Pilot conducted but findings not clearly addressed in intervention for main evaluation	The pilot work led to a modification of the control intervention but unclear as to whether this also happened for the novel intervention.
		No pilot reported	No piloting of intervention reported
Intervention and control	Content and dose	Intervention components and dose clearly described	The content and the dose of the exercise programme were described in detail.
		Intervention components clearly described but dose was not standardised	The content of the programme was well described but no specific dose was prescribed.
		Intervention not replicable from description of components and dose	Intervention was based on usual practice and had no protocol or guidance on minimum dose.
	Tailoring	Formalised assessment to inform tailoring	An assessment tool was used to determine the individuals level of exercise intensity
		Clinical judgement only used to inform tailoring	Therapists used their clinical judgement to individually tailor programmes.
		Not adequately reported	Intervention individually tailored but no information as to how this was undertaken.
	Adherence support strategies	Explicit strategies to support adherence to the intervention clearly reported	Specific adherence strategies described as part of the intervention.
		No clear information regarding adherence support strategies	No information reported regarding adherence strategies.
		Supporting adherence is not relevant to the intervention	The intervention was passive and adherence strategies not relevant.	NA
	Intervention training	Standardised training in intervention received +/- additional/ongoing support or training	Staff attended a 1.5-day training session and had an additional support session with ongoing contact from research team.
		No standardised intervention training received but staff delivering described to be experienced in the intervention or training of staff unclear/not reported	Staff have postgraduate training in the intervention but no study-specific training reported.
	Control description	Active control/attention control/usual care with some standardised components	Control was an active intervention that differed from intervention only in terms of delivery setting.
		Usual care had no standardised components	Control was usual care and was not standardised between sites.

Key: High quality Some/Unclear quality Limited quality.
PPI, Patient and Public Involvement.