The Jurca Non-Exercise Test is a simple and safe test to determine fitness level without having to do any exercise, using a regression equation using age, gender, body mass index (BMI), and self-reported physical activity levels to estimate VO2 max.

VO2 Max is the maximum amount of oxygen the body can utilize during intense exercise, and it is considered one of the best indicators of aerobic fitness. The higher your VO2 max, the better your cardiovascular fitness.

The Pittsburg Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. The PSQI consists of 19 individual items that are grouped into 7 components: Subjective Sleep Quality, Sleep Latency (Time Taken to Fall Asleep), Sleep Duration, Sleep Efficiency, Sleep Disturbances, Use of Sleep Medications, and Daytime Dysfunction.

Each component assesses a specific aspect of sleep quality scored on a 0 to 3 scale based on the responses (higher scores indicating worse sleep quality). The total score for each component is calculated by adding the individual responses within that component. The scores are then summed to generate the PSQI global score, which helps classify sleep quality as "Good sleep quality" (0-4), "mild sleep problems" (5-10), "moderate sleep problems" (11-15), or "severe sleep problems" (16-21).

The Perceived Stress Scale (PSS) is a measure of the degree to which situations in one's life are appraised as stressful. It focuses on how often a person feels overwhelmed, unable to cope, or unsure about their ability to handle challenges in the past month. It includes both the frequency and severity of perceived stressors.

The PSS consists of 10 questions designed to assess feelings of unpredictability, lack of control, and feeling overwhelmed, as well as how often the individual felt nervous, upset, or helpless. Each item on the PSS is scored on a 5-point scale, ranging from 0 to 4: Never (0), Almost never (1), Sometimes (2), Fairly often (3), and Very often (4).

The total score on the PSS indicates the level of perceived stress over the past month. Generally, the higher the score, the higher the perceived stress. PSS Score Ranges: 0-13: Low perceived stress, 14-26: Moderate perceived stress, and 27-40: High perceived stress.

The Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) consists of 12 items that assess two key dimensions of spiritual well-being:

• Spiritual Well-Being: This measures the individual's sense of meaning and peace, connection to a higher power or a greater purpose, and the extent to which their spiritual beliefs contribute to their coping strategies and overall well-being.
• Faith: This dimension measures how the individual's religious or spiritual beliefs help them make sense of their experiences and provide strength or comfort in times of adversity.

Each of the 12 items is rated on a 5-point Likert scale, ranging from 0 to 4:

0: Not at all (never true), 1: A little bit (rarely true), 2: Somewhat (sometimes true), 3: Quite a bit (often true), and 4: Very much (always true).

Scores are summed to give a total spiritual well-being score. The total score typically ranges from 0 to 48, with higher scores indicating better spiritual well-being.

The Exercise Barriers Self-Efficacy (BSE) scores range from 0 to 100 for each item, with total or average scores calculated across multiple items.

Interpretation:

• Higher scores indicate greater confidence in overcoming barriers to exercising, such as time constraints or lack of motivation.
• Lower scores suggest lower self-efficacy in handling challenges to exercise adherence.

The Modeling of Exercise scores range varies, but often rated on a scale (e.g., 1 to 5 or 0 to 10) across several items related to observing others (e.g., family or friends) engaging in exercise. Total scores are summed or averaged.

Interpretation:

• Higher scores reflect greater exposure to role models for exercise, which could include parents, peers, or significant others.
• Lower scores indicate less exposure to individuals modeling exercise behavior.

The Exercise Self-Efficacy (ESE) scores range from 0 to 100 for each item, with total or average scores calculated across multiple items.

Interpretation:

Higher scores denote greater confidence in one's ability to engage in regular exercise under various circumstances, such as bad weather or after a long workday.

Lower scores imply a lack of confidence in maintaining exercise habits consistently.

The Exercise Social Support Family (SSFA) scores are scaled responses from each item (e.g., 1 to 5 or 0 to 10), which are summed or averaged to create a total score.

Interpretation:

• Higher scores indicate greater perceived support from family members for exercise, such as encouragement, assistance, or participation.
• Lower scores suggest limited family support for exercise behaviors.

The Exercise Social Support Friends (SSFR) scores are similar to SSFA: Scaled responses for each item (e.g., 1 to 5 or 0 to 10), summed or averaged to create a total score.

Interpretation:

• Higher scores reflect greater support from friends, such as exercising together or offering encouragement.
• Lower scores indicate less perceived social support for exercise from peers.

Likert scale scores (e.g., 1 to 7 or 1 to 10), summed or averaged to create a total score.

Interpretation:

• Higher scores represent stronger identification with being an exerciser, suggesting that exercise is a significant part of the individual's self-concept.
• Lower scores indicate weaker identification with the identity of being an exerciser.

The Body Image Scale for Cancer Survivors (BIS-C) asks patients to rate their body image on a scale of 0-3, with 0 meaning "not at all" (indicating no issue with body image), and 3 meaning "very much" (indicating significant body image concerns). The 10 items cover a range of topics, such as how satisfied the patient is with their appearance, how they feel about their body, and whether they find it difficult to look at themselves naked.

Summary of BIS-C Score Ranges:

0-10: Minimal body image concerns 11-20: Moderate body image concerns 21-30: Significant body image distress 31-40: Severe body image distress

The Adult Dispositional Hope Scale (ADHS) consists of 12 items and uses a Likert-type scale, with each item being rated from 1 ("Definitely False") to 8 ("Definitely True"). The items are divided into Agency and Pathways subscales, and the total score can be calculated by summing all items.

Each item is rated on an 8-point scale, from 1 to 8, with 4 items measuring Agency and 4 items measuring Pathways. Some items are reverse-scored (e.g., negatively worded items). The possible range of scores for the ADHS is 12 to 96. Agency and Pathways scores range from 4 to 32.

Interpretation of total scores: Low Hope (12 to 35), Moderate Hope (36 to 60), and High Hope (61 to 96).

Subscale Interpretation: Higher Agency scores reflect stronger feelings of personal motivation and self-efficacy to initiate and sustain goal-directed actions; and higher score on the Pathways subscale reflects the belief that solutions and strategies are available to overcome obstacles and achieve goals.

The Brief Personal Meaningful Profile (PMP-B) is intended to identify what really matters in the patient's life. It measures people's perception of personal meaning in their lives.

The scale typically uses a Likert-type scale, often ranging from 1 to 5, where participants indicate how much they agree or disagree with statements about the meaningfulness of various aspects of their life (e.g., relationships, work, personal growth, etc.).

Interpretation of Scores: Low Meaning (Lower Scores; 5-10), Moderate Meaning (Mid-Range Scores; 11-20), High Meaning (Higher Scores; 21-25)

The Brief Symptom Inventory-18 (BSI-18) is a self-report checklist that measures psychological distress and symptoms. It contains 18 items across 3 key symptom domains (Somatization, Depression, Anxiety; 6 items in each), and is used to evaluate emotional functioning and identify the severity of psychological symptoms over a specified time period. Each item is rated on a 5-point Likert scale, reflecting the severity of symptoms over the past week.

Minimum score: 0 (if the individual selects "Not at all" for every item). Maximum score: 72 (if the individual selects "Extremely" for every item).

The BSI-18 is scored by summing the responses to all 18 items, with higher scores indicating significant distress. A score above 63 on any dimension is considered clinically significant.

The Center for Epidemiological Studies-Depression Scale (CES-D) is a 20-item measure that asks caregivers to rate how often over the past week they experienced symptoms associated with depression, such as restless sleep, poor appetite, and feeling lonely. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Scores range from 0 to 60, with high scores indicating greater depressive symptoms.

The 6MWT is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity.

The longer the distance covered, the better.

Balance will be assessed while standing on a pressure mat with feet together, eyes opened and closed, for 30 seconds in each condition. Investigators will record data on the 'sway path distance' (displacement of the center of gravity in centimeters) in the two conditions. Longer distances indicate higher balance deficits.

• elbow flexors and shoulder elevators (i.e., upright row) isometric strength (in kilograms) will be tested using a strength dynamometer system in standardized positions;
• Dominant hand grip strength in kilograms will be tested using a hand dynamometer;
• Tests are performed three times and the best result is recorded.

This test will be used to assess trunk and lower extremity flexibility. Test is performed three times and the best length is recorded.

Baseline and end-of-study blood samples will be collected into K2-EDTA tubes and centrifuged to separate and aliquot plasma for subsequent cytokine protein analysis. Samples will be analyzed in duplicate using the Flex-Map 3D platform system (Luminex, Austin, TX) with the MILLIPLEX MAP Human Cytokine Panel A (HCYTA-60 K-08 with TNF-α, IL-1ra, IL-1β, IL-4, IL-6, IL-8, IL-10, and IFN-γ), Human Soluble Cytokine Receptor Panel (HSCRMAG-32 K-03 with sTNFRII, sTNFRII, and sIL-6R) and Milliplex-Human CVD Panel 3 with CRP (HCVD3MAG-67 K-01).

Physical activity will be measured by accelerometers (Actigraph GTX9, Actigraph, Inc. FL). Participants will be given the accelerometer one week prior to beginning the intervention to get their baseline physical activity levels. After the physical functional assessments, they will be given the accelerometers to wear on their wrist during the intervention to measure their changes in physical activity.