Comparative effects of square-stepping and strengthening exercises on cognitive and balance functions in chronic obstructive pulmonary disease: a randomized clinical trial
Bibliographic record
Abstract
Background Cognitive impairment and balance dysfunction are common in individuals with chronic obstructive pulmonary disease (COPD), yet targeted interventions remain limited. Square-stepping exercise (SSE), a structured multitasking intervention involving progressive, multi-directional step patterns, combines cognitive and motor challenges. This study aimed to compare the effects of SSE and traditional strengthening exercises (SE) on cognitive function and balance in individuals with COPD through a telerehabilitation model. Methods This randomized clinical trial included 34 male individuals with mild to moderate COPD (mean age: 63.91 ± 6.98 years), randomly assigned to SSE and SE groups (n = 17 each). Both groups participated in supervised telerehabilitation sessions three times per week for eight weeks. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA; 0–30 points, with higher scores indicating better cognition), while the Standardized Mini-Mental State Examination (SMMSE; 0–30, cutoff < 23) was used as a screening tool to exclude significant cognitive impairment. Balance performance was evaluated using the Biodex Balance System, including the overall stability index, anterior/posterior index, and medial/lateral index (lower scores indicate better balance). Perceived breathlessness (dyspnea) was assessed with the Modified Medical Research Council (mMRC) scale (0–4), and disease impact with the COPD Assessment Test (CAT; 0–40, ≥10 indicating high symptom burden). Comorbidity severity was evaluated using the modified Charlson Comorbidity Index (CCI; higher scores indicate greater severity). Data normality was assessed using the Shapiro–Wilk test. Independent sample t-tests were used for parametric between-group comparisons, and Mann–Whitney U tests were applied for non-parametric data. Paired sample t-tests and Wilcoxon signed-rank tests were used for within-group comparisons. The level of statistical significance was set at p < 0.05. Results Both groups showed significant within-group improvement in MoCA scores (p = 0.01 for both). However, the SSE group demonstrated greater improvements in balance parameters, particularly in the overall stability index (p = 0.014) and anterior/posterior stability index (p = 0.05), compared to the SE group. The SE group showed limited improvements, primarily in static balance conditions (p = 0.029). Although cognitive gains were similar between the groups, balance improvements were more pronounced in the SSE group. Conclusions While both exercise modalities improved cognitive function in individuals with COPD, SSE led to superior outcomes in balance control. The multitasking design of SSE, requiring simultaneous cognitive processing and motor coordination, may underlie its enhanced impact on postural stability. These findings support SSE as a technically advantageous and accessible intervention in telerehabilitation for individuals with COPD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".