{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T14:23:30Z","timestamp":1794493410842,"version":"4.9.1"},"reference-count":95,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Danish Cancer Society","award":["R355-A20616-23-S3"],"award-info":[{"award-number":["R355-A20616-23-S3"]}],"id":[{"id":"https:\/\/ror.org\/03ytt7k16","id-type":"ROR","asserted-by":"crossref"}]},{"name":"The Danish Health Foundation","award":["21-B-0081"],"award-info":[{"award-number":["21-B-0081"]}]},{"name":"The Danish National Research Center for Lung Cancer, Danish Cancer Society","award":["R198-A14299"],"award-info":[{"award-number":["R198-A14299"]}],"id":[{"id":"https:\/\/ror.org\/03ytt7k16","id-type":"ROR","asserted-by":"crossref"}]},{"name":"The Danish Lung Foundation","award":["Rp175-R8-A47"],"award-info":[{"award-number":["Rp175-R8-A47"]}]},{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF23OC0083460"],"award-info":[{"award-number":["NNF23OC0083460"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,6,28]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patients who have undergone curative surgery for non-small cell lung cancer (NSCLC) often experience long-term reduced quality of life (QoL), high symptom burden, risk of physical deconditioning and comorbidity. Current Danish rehabilitation offers are heterogeneous and not specifically tailored to the disease-specific needs and no long-term targeted support is currently available. Previously, singing\u2014delivered as a structured training modality\u2014has conferred both physiological and psychological improvements in chronic obstructive pulmonary disease, which may likely be transferable to NSCLC, as the two conditions share overlapping symptoms and characteristics. We aim to explore whether a singing-based intervention improves physical function, QoL and symptom burden 6\u201318 months postsurgery in NSCLC. Moreover, we aim to explore the underpinning physiological mechanisms of singing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We will conduct a multicentre randomised controlled trial, comparing 10 weeks\u2019 online-delivered structured singing training to usual care. Trial outcomes include primary outcome, physical capacity (measure: Six-Minute Walking Test), and secondary outcomes, QoL and symptoms (measures: St. George\u2019s Respiratory Questionnaire (SGRQ); the European Organisation for Research and Treatment of Cancer Questionnaire (QLQ-C30; QLQ-LC13); Hospital Anxiety and Depression Scale (HADS) and airway physiology (measure: forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)). Explorative outcomes include aerobic fitness\/maximal oxygen uptake (VO\n                      <jats:sub>2<\/jats:sub>\n                      -max); exercise-induced adaptations; respiratory muscle strength and control; inflammatory biomarkers. Analysis: Descriptive statistics, stratified analyses, regression models and association and independence between objective and subjective outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The trial was approved by the Committee on Health Research Ethics (SJ-1027) and the Danish Act on Processing of Personal Data (p-2024-19634). Results will be reported in peer-reviewed scientific journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07460999\">NCT07460999<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004382","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:15:18Z","timestamp":1783682118000},"page":"e004382","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sing-a-Lung 2.0: protocol for a multicentre randomised controlled trial to investigate the effects and mechanisms of online-delivered singing training versus usual care 6\u201318 months after surgical resection for non-small cell lung cancer (NSCLC)"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct07460999","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07460999","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3833-2943","authenticated-orcid":false,"given":"Mette","family":"Kaasgaard","sequence":"first","affiliation":[{"name":"Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"},{"name":"Department of Medicine, Pulmonary Research Unit (PLUZ), Zealand University Hospital Roskilde, Naestved, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6204-2623","authenticated-orcid":false,"given":"Morten","family":"Borg","sequence":"additional","affiliation":[{"name":"Department of Regional Health Research, University of Southern Denmark Faculty of Science, Odense, Denmark"},{"name":"Department of Medicine, Lillebaelt Hospital, Vejle, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Hostrup","sequence":"additional","affiliation":[{"name":"August Krogh Section for Molecular and Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Borbjerg","family":"Laursen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Medicine, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-7987","authenticated-orcid":false,"given":"Lotte Holm","family":"Land","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"},{"name":"Department of Oncology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitte","family":"Alstrup","sequence":"additional","affiliation":[{"name":"Department of Medicine Roskilde and Naestved, Pulmonary Research Unit (PLUZ), Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Orholm","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie Kissow","family":"Kristensen","sequence":"additional","affiliation":[{"name":"August Krogh Section for Molecular and Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4322-1642","authenticated-orcid":false,"given":"Mikkel Bj\u00f8rck","family":"Naver","sequence":"additional","affiliation":[{"name":"August Krogh Section for Molecular and Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole","family":"Hilberg","sequence":"additional","affiliation":[{"name":"Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark"},{"name":"Department of Medicine, Lillebaelt Hospital, Vejle, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uffe","family":"Bodtger","sequence":"additional","affiliation":[{"name":"Department of Regional Health Research, University of Southern Denmark Faculty of 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