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. 2021 Jun 21;23:173. doi: 10.1186/s13075-021-02544-5

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 2 — Primary outcomes objectively assessing muscle strength and endurance in the intervention and control group. In the intervention group (IG), the 24-week intervention led to a significant improvement in muscle strength objectively assessed by Manual Muscle Testing (MMT)-8 (A) and muscle endurance evaluated by Functional Index (FI)-2 (C), thus preventing the progressive deterioration observed in the control group (CG) over weeks 0–24. Although the improvement in MMT-8 (A) and FI-2 (C) in the IG was still present at week 48, the maximum effects were not sustained. In the IG, the improvement in MMT-8 (B) and FI-2 (D) was clinically meaningful (a 24-week improvement by >20%) in a substantial proportion of patients. Data in A and C are presented as the mean ± standard error of the mean (whiskers). Data in the tree diagrams (B and D) present the percentage distribution of patients by outcome, which is stratified into five levels of improvement/deterioration over weeks 0–24. w, week; p*, unadjusted inter-group comparison by two-way ANOVA; p, unadjusted intra-group comparison by one-way ANOVA in black (IG) and gray (CG); p†, difference in the overall distribution in five levels of the patient outcome by chi-square test; p‡, difference in the category of clinically meaningful improvement by chi-square test