Table 1 Potential improvements of LEAP

1.

There will be individual variations related to when LEAP is most suitably initiated in relation to the standard treatment, but the final phase seems preferrable.

2.

Clinicians need to inform patients that there might be an initial negative, yet transitory, effect on CE.

3.

Clinicians also need to address social comparison early on.

4.

Evaluate whether session time could be slightly extended.

5.

Increase support around the behavioral challenge and spend more time focusing this during the sessions.

6.

Allocate plenty of session time for discussions.

7.

Evaluate whether LEAP can be delivered less frequently (i.e., one session/week), alternatively whether a booster session a few weeks post LEAP could be added.

8.

Make LEAP more integrated with standard treatment by assuring a temporary special focus on PA and CE also in standard treatment during LEAP.

9.

Groups should preferably be held by a physiotherapist and a psychologist/psychotherapist.

10.

Evaluate if safe, guided PA could be added as a complement.