{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:26:54Z","timestamp":1772166414769,"version":"3.50.1"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trials"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence has shown that patients with chronic obstructive pulmonary disease present significant deficits in the control of postural balance when compared to healthy subjects. In view of this, it is pertinent to investigate the effects of different therapeutic strategies used alone or in association with pulmonary rehabilitation with the potential to improve postural balance and other outcomes with clinical significance in patients with chronic obstructive pulmonary disease. This study will investigate the effects of an 8-week (short-term) multimodal exercise program [inspiratory muscle training (IMT) plus neuromuscular electrical stimulation (NMES)] on postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program compared to individualized addition of IMT or NMES to pulmonary rehabilitation or standard pulmonary rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a randomized, single-blind, 4-parallel-group trial. Forty patients with chronic obstructive pulmonary disease will be included prospectively to this study during a pulmonary rehabilitation program. Patients will be randomly assigned to one of four groups: multimodal exercise program (IMT + NMES + pulmonary rehabilitation group) or (IMT + pulmonary rehabilitation group) or (NMES + pulmonary rehabilitation group) or standard pulmonary rehabilitation group. Patients will receive two sessions per week for 8 weeks. The primary outcome will be static postural balance and secondary outcomes will include as follows: static and dynamic postural balance, fear of falling, muscle strength and endurance (peripheral and respiratory), functional capacity, health-related quality of life, muscle architecture (quadriceps femoris and diaphragm), and laboratory biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This randomized clinical trial will investigate the effects of adding of short-term multimodal exercise program, in addition to pulmonary rehabilitation program, in postural balance in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation. Furthermore, this randomized control trial will enable important directions regarding the effectiveness of short-term intervention as part of the need to expand the focus of pulmonary rehabilitation to include balance management in chronic obstructive pulmonary disease patients which will be generated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04387318. Registered on May 13, 2020.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-023-07558-9","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T21:02:04Z","timestamp":1692046924000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of multimodal exercise program on postural balance in patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial"],"prefix":"10.1186","volume":"24","author":[{"given":"Tamires","family":"Daros dos Santos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriane Schmidt","family":"Pasqualoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dannuey Machado","family":"Cardoso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana Beatrice M\u00e2nica","family":"Da Cruz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael Noal","family":"Moresco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aron","family":"Ferreira da Silveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7256-1881","authenticated-orcid":false,"given":"Isabella","family":"Martins de Albuquerque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"7558_CR1","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/978-3-030-68748-9_11","volume":"1304","author":"L Zuo","year":"2021","unstructured":"Zuo L, Wijegunawardana D. Redox role of ROS and inflammation in pulmonary diseases advances in experimental medicine and biology. Adv Exp Med Biol. 2021;1304:187\u2013204. https:\/\/doi.org\/10.1007\/978-3-030-68748-9_11.","journal-title":"Adv Exp Med Biol"},{"key":"7558_CR2","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.mrgentox.2019.04.003","volume":"843","author":"P Russo","year":"2019","unstructured":"Russo P, Lamonaca P, Milic M, et al. Biomarkers of DNA damage in COPD patients undergoing pulmonary rehabilitation: integrating clinical parameters with genomic profiling. Mutat Res Gen Tox En. 2019;843:111\u20137. https:\/\/doi.org\/10.1016\/j.mrgentox.2019.04.003.","journal-title":"Mutat Res Gen Tox En"},{"issue":"4","key":"7558_CR3","doi-asserted-by":"publisher","first-page":"2300239","DOI":"10.1183\/13993003.00239-2023","volume":"61","author":"A Agust\u00ed","year":"2023","unstructured":"Agust\u00ed A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J. 2023;61(4):2300239. https:\/\/doi.org\/10.1183\/13993003.00239-2023.","journal-title":"Eur Respir J"},{"key":"7558_CR4","doi-asserted-by":"publisher","first-page":"413","DOI":"10.3109\/15412555.2014.974737","volume":"12","author":"E Barreiro","year":"2015","unstructured":"Barreiro E, Gea J. Respiratory and limb muscle dysfunction in COPD. COPD. 2015;12:413\u201326. https:\/\/doi.org\/10.3109\/15412555.2014.974737.","journal-title":"COPD"},{"key":"7558_CR5","doi-asserted-by":"publisher","first-page":"3301","DOI":"10.2147\/COPD.S145910","volume":"12","author":"H Lee","year":"2017","unstructured":"Lee H, Jhun BW, Cho J, et al. Different impacts of respiratory symptoms and comorbidities on COPD-specific health- related quality of life by COPD severity. Int J Chron Obstruct Pulmon Dis. 2017;12:3301\u201310. https:\/\/doi.org\/10.2147\/COPD.S145910.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"7558_CR6","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1136\/thoraxjnl-2019-213608","volume":"75","author":"KJ Loughran","year":"2020","unstructured":"Loughran KJ, Atkinson G, Beauchamp MK, et al. Balance impairment in individuals with COPD: a systematic review with meta-analysis. Thorax. 2020;75:539\u201345. https:\/\/doi.org\/10.1136\/thoraxjnl-2019-213608.","journal-title":"Thorax"},{"key":"7558_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rmed.2020.106284","volume":"176","author":"CC Oliveira","year":"2021","unstructured":"Oliveira CC, Annoni R, Lee AL, et al. Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: a systematic review. Respir Med. 2021;176:1\u201312. https:\/\/doi.org\/10.1016\/j.rmed.2020.106284.","journal-title":"Respir Med"},{"key":"7558_CR8","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1164\/rccm.201309-1634ST","volume":"188","author":"MA Spruit","year":"2013","unstructured":"Spruit MA, Singh SJ, Garvey C, et al. An Official American Thoracic Society\/European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188:e13\u201364. https:\/\/doi.org\/10.1164\/rccm.201309-1634ST.","journal-title":"Am J Respir Crit Care Med"},{"key":"7558_CR9","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1097\/HCR.0000000000000171","volume":"36","author":"C Garvey","year":"2016","unstructured":"Garvey C, Bayles MP, Hamm LF, et al. Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: review of selected Guidelines. An Official Statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 2016;36:75\u201383. https:\/\/doi.org\/10.1097\/HCR.0000000000000171.","journal-title":"J Cardiopulm Rehabil Prev"},{"issue":"1","key":"7558_CR10","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2147\/COPD.S63955","volume":"10","author":"E Porto","year":"2015","unstructured":"Porto E, Mattos de Castro AA, Schmidt V, Rabelo H, Kumpel C, Nascimento O, Jardim JR. Postural control in chronic obstructive pulmonary disease: a systematic review. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1233\u20139. https:\/\/doi.org\/10.2147\/COPD.S63955.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"7558_CR11","doi-asserted-by":"publisher","first-page":"e0208697","DOI":"10.1371\/journal.pone.0208697","volume":"13","author":"J Kocjani","year":"2018","unstructured":"Kocjani J, Gzik-Zroska B, Nowakowska K, et al. Impact of diaphragm function parameters on balance maintenance. PLoS One. 2018;13:e0208697. https:\/\/doi.org\/10.1371\/journal.pone.0208697.","journal-title":"PLoS One"},{"issue":"9","key":"7558_CR12","doi-asserted-by":"publisher","first-page":"e0257595","DOI":"10.1371\/journal.pone.0257595","volume":"16","author":"B Tounsi","year":"2021","unstructured":"Tounsi B, Acheche A, Lelard T, et al. Effects of specific inspiratory muscle training combined with wholebody endurance training program on balance in COPD patients: randomized controlled trial. PLoS One. 2021;16(9):e0257595. https:\/\/doi.org\/10.1371\/journal.pone.0257595.","journal-title":"PLoS One"},{"key":"7558_CR13","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1177\/0269215518791658","volume":"33","author":"M Mekki","year":"2019","unstructured":"Mekki M, Paillard T, Sahli S, et al. Effect of adding neuromuscular electrical stimulation training to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: randomized clinical trial. Clin Rehabil. 2019;33:195\u20132060. https:\/\/doi.org\/10.1177\/0269215518791658.","journal-title":"Clin Rehabil"},{"issue":"5","key":"7558_CR14","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1080\/1354750X.2018.1452049","volume":"23","author":"J Schardong","year":"2018","unstructured":"Schardong J, Brito VB, Dipp T, Macagnan FE, Saffi J, M\u00e9a Plentz RD. Intradialytic neuromuscular electrical stimulation reduces DNA damage in chronic kidney failure patients: a randomized controlled trial. Biomarkers. 2018;23(5):495\u2013501. https:\/\/doi.org\/10.1080\/1354750X.2018.1452049.","journal-title":"Biomarkers"},{"key":"7558_CR15","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.gaitpost.2012.07.009","volume":"37","author":"F Scoppa","year":"2013","unstructured":"Scoppa F, Capra R, Gallamini M, et al. Clinical stabilometry standardization: Basic definitions acquisition interval sampling frequency. Gait Posture. 2013;37:290\u20132. https:\/\/doi.org\/10.1016\/j.gaitpost.2012.07.009.","journal-title":"Gait Posture"},{"issue":"9","key":"7558_CR16","doi-asserted-by":"publisher","first-page":"1782","DOI":"10.1016\/j.apmr.2008.01.020","volume":"89","author":"K Hill","year":"2008","unstructured":"Hill K, Jenkins SC, Cecins N, et al. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2008;89(9):1782\u20137. https:\/\/doi.org\/10.1016\/j.apmr.2008.01.020.","journal-title":"Arch Phys Med Rehabil"},{"key":"7558_CR17","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1590\/S1413-35552010000300003","volume":"14","author":"M Duarte","year":"2010","unstructured":"Duarte M, Freitas SMSF. Revision of posturography based on force plate for balance evaluation. Rev Bras Fisioter. 2010;14:183\u201392. https:\/\/doi.org\/10.1590\/S1413-35552010000300003.","journal-title":"Rev Bras Fisioter"},{"issue":"4","key":"7558_CR18","first-page":"287","volume":"60","author":"LA Castagno","year":"1994","unstructured":"Castagno LA. A new method for sensory organization tests: the foam-laser dynamic posturography. Rev Bras Otorrinolaringol. 1994;60(4):287\u201396.","journal-title":"Rev Bras Otorrinolaringol"},{"key":"7558_CR19","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1016\/j.apmr.2013.03.024","volume":"94","author":"R Mesquita","year":"2013","unstructured":"Mesquita R, Janssen DJA, Wouters EFM, et al. Within-day test-retest reliability of the Timed Up & Go test in patients with advanced chronic organ failure. Am J Phys Med Rehabil. 2013;94:2131\u20138. https:\/\/doi.org\/10.1016\/j.apmr.2013.03.024.","journal-title":"Am J Phys Med Rehabil"},{"key":"7558_CR20","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1590\/S0100-879X2004000900017","volume":"37","author":"ST Miyamoto","year":"2004","unstructured":"Miyamoto ST, Junior IL, Berg KO, et al. J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004;37:1411\u201321. https:\/\/doi.org\/10.1590\/S0100-879X2004000900017.","journal-title":"Braz J Med Biol Res."},{"key":"7558_CR21","doi-asserted-by":"publisher","first-page":"484","DOI":"10.2522\/ptj.20080071","volume":"89","author":"FB Horak","year":"2009","unstructured":"Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther. 2009;89:484\u201398. https:\/\/doi.org\/10.2522\/ptj.20080071.","journal-title":"Phys Ther"},{"key":"7558_CR22","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1093\/ageing\/afp225","volume":"39","author":"K Delbaere","year":"2010","unstructured":"Delbaere K, Close JCT, Mikolaizak AS, et al. The Falls Efficacy Scale international (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010;39:210\u20139. https:\/\/doi.org\/10.1093\/ageing\/afp225.","journal-title":"Age Ageing."},{"key":"7558_CR23","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1590\/S1413-35552012005000072","volume":"17","author":"AP Marques","year":"2013","unstructured":"Marques AP, Mendes YC, Taddei U, et al. Brazilian-Portuguese translation and cross cultural adaptation of the activities-specific balance confidence (ABC) scale. Braz J Phys Ther. 2013;17:170\u20138. https:\/\/doi.org\/10.1590\/S1413-35552012005000072.","journal-title":"Braz J Phys Ther"},{"key":"7558_CR24","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1164\/rccm.166.4.518","volume":"166","author":"American Thoracic Society\/European Respiratory Society (ATS\/ERS)","year":"2002","unstructured":"American Thoracic Society\/European Respiratory Society (ATS\/ERS). Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166:518\u2013624. https:\/\/doi.org\/10.1164\/rccm.166.4.518.","journal-title":"Am J Respir Crit Care Med"},{"key":"7558_CR25","doi-asserted-by":"publisher","first-page":"50","DOI":"10.4187\/respcare.03947","volume":"61","author":"RPP Basso-Vanelli","year":"2016","unstructured":"Basso-Vanelli RPP, Di Lorenzo VAP, Labadessa IG, et al. Effects of inspiratory muscle training and calisthenics-and-breathing exercises in COPD with and without respiratory muscle weakness. Respir Care. 2016;61:50\u201360. https:\/\/doi.org\/10.4187\/respcare.03947.","journal-title":"Respir Care"},{"key":"7558_CR26","doi-asserted-by":"publisher","first-page":"562","DOI":"10.3109\/09593985.2011.640385","volume":"28","author":"RW Bohannon","year":"2012","unstructured":"Bohannon RW, Kindig J, Sabo G, et al. Isometric knee extension force measured using a handheld dynamometer with and without belt-stabilization. Physiother Theory Pract. 2012;28:562\u20138. https:\/\/doi.org\/10.3109\/09593985.2011.640385.","journal-title":"Physiother Theory Pract"},{"key":"7558_CR27","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","volume":"70","author":"CJ Jones","year":"1999","unstructured":"Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70:113\u20139. https:\/\/doi.org\/10.1080\/02701367.1999.10608028.","journal-title":"Res Q Exerc Sport"},{"issue":"10","key":"7558_CR28","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.4187\/respcare.06694","volume":"64","author":"A Zanini","year":"2019","unstructured":"Zanini A, Crisafulli E, D'Andria M, et al. Minimum clinically important difference in 30-s sit-to-stand test after pulmonary rehabilitation in subjects with COPD. Respir Care. 2019;64(10):1261\u201369. https:\/\/doi.org\/10.4187\/respcare.06694.","journal-title":"Respiratory Care"},{"key":"7558_CR29","doi-asserted-by":"publisher","unstructured":"Holland AE, Spruit MA, Troosters T, et al. An official European respiratory society\/American thoracic society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428\u201346. https:\/\/doi.org\/10.1183\/09031936.00150314.","DOI":"10.1183\/09031936.00150314"},{"issue":"3","key":"7558_CR30","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1590\/S0102-35862000000300004","volume":"26","author":"TC Sousa","year":"2000","unstructured":"Sousa TC, Jardim JR, Jones P. Validation of the Saint George\u2019s Respiratory Questionnaire in patients with chronic obstructive pulmonary disease in Brazil. J Bras Pneumol. 2000;26(3):119\u201328. https:\/\/doi.org\/10.1590\/S0102-35862000000300004.","journal-title":"J Bras Pneumol"},{"key":"7558_CR31","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1177\/0148607115575033","volume":"40","author":"T Fivez","year":"2016","unstructured":"Fivez T, Hendrickx A, Herpe TV, et al. An analysis of reliability and accuracy of muscle thickness ultrasonography in critically ill children and adults. JPEN J Parenter Enteral Nutr. 2016;40:944\u20139. https:\/\/doi.org\/10.1177\/0148607115575033.","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"7558_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4037\/ajcc2016563","volume":"25","author":"CA Francis","year":"2016","unstructured":"Francis CA, Hoffer JA, Reynolds S. Ultrasonographic evaluation of diaphragm thickness during mechanical ventilation in intensive care patients. Am J Crit Care. 2016;25:1\u20138. https:\/\/doi.org\/10.4037\/ajcc2016563.","journal-title":"Am J Crit Care"},{"key":"7558_CR33","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.clinbiochem.2010.12.011","volume":"44","author":"E Tatsch","year":"2011","unstructured":"Tatsch E, Bochi GV, Pereira RS, et al. A simple and in expressive automated technique for measurement of serum nitrite\/nitrate. Clin Biochem. 2011;44:348\u201350. https:\/\/doi.org\/10.1016\/j.clinbiochem.2010.12.011.","journal-title":"Clin Biochem"},{"key":"7558_CR34","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.mrfmmm.2004.06.035","volume":"556","author":"O Garc\u00eda","year":"2004","unstructured":"Garc\u00eda O, Mandina T, Lamadrid AI, Diaz A, Remigio A, Gonzalez Y, Piloto J, Gonzalez JE, Alvarez A. Sensitivity and variability of visual scoring in the comet assay. Results of an inter-laboratory scoring exercise with the use of silver staining. Mutat Res. 2004;556:25\u201334. https:\/\/doi.org\/10.1016\/j.mrfmmm.2004.06.035.","journal-title":"Mutat Res"},{"issue":"1","key":"7558_CR35","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1590\/s1808-86942011000100018","volume":"77","author":"AB Fronza","year":"2011","unstructured":"Fronza AB, Barreto DC, Tochetto TM, Cruz IB, Silveira AF. Associa\u00e7\u00e3o entre fun\u00e7\u00f5es da via auditiva eferente e genotoxicidade em adultos jovens [Association between auditory pathway efferent functions and genotoxicity in young adults]. Braz J Otorhinolaryngol. 2011;77(1):107\u201314. https:\/\/doi.org\/10.1590\/s1808-86942011000100018.","journal-title":"Braz J Otorhinolaryngol."},{"key":"7558_CR36","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/0921-8777(94)00043-6","volume":"336","author":"A Collins","year":"1995","unstructured":"Collins A, Ma AG, Duthie SJ. The kinetics of repair of oxidative DNA damage (strand breaks and oxidized pyrimidines) in human cells. Mutat Res\/DNA Repair. 1995;336:69\u201377. https:\/\/doi.org\/10.1016\/0921-8777(94)00043-6.","journal-title":"Mutat Res\/DNA Repair"},{"issue":"11","key":"7558_CR37","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.4187\/respcare.04749","volume":"61","author":"LA de Castro","year":"2016","unstructured":"de Castro LA, Ribeiro LRG, Mesquita R, et al. Static and functional balance in individuals with COPD: comparison with healthy controls and differences according to sex and disease severity. Respir Care. 2016;61(11):1488\u201396. https:\/\/doi.org\/10.4187\/respcare.04749.","journal-title":"Respir Care"},{"issue":"5","key":"7558_CR38","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1513\/AnnalsATS.202102-146ST","volume":"18","author":"AE Holland","year":"2021","unstructured":"Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. An Official American Thoracic Society workshop report. Ann Am Thorac Soc. 2021;18(5):e12\u201329. https:\/\/doi.org\/10.1513\/AnnalsATS.202102-146ST.","journal-title":"Ann Am Thorac Soc"},{"issue":"3","key":"7558_CR39","doi-asserted-by":"publisher","first-page":"e57949","DOI":"10.1371\/journal.pone.0057949","volume":"8","author":"L Janssens","year":"2013","unstructured":"Janssens L, Brumagne S, McConnell AK, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One. 2013;8(3):e57949. https:\/\/doi.org\/10.1371\/journal.pone.0057949.","journal-title":"PLoS One"},{"issue":"4","key":"7558_CR40","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1183\/09031936.03.00040703","volume":"22","author":"PJ Barnes","year":"2003","unstructured":"Barnes PJ, Shapiro SD, Pauwels RA. Chronic obstructive pulmonary disease: molecular and cellular mechanisms. Eur Respir J. 2003;22(4):672\u201388. https:\/\/doi.org\/10.1183\/09031936.03.00040703.","journal-title":"Eur Respir J"}],"container-title":["Trials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-023-07558-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13063-023-07558-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-023-07558-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T18:16:14Z","timestamp":1700417774000},"score":1,"resource":{"primary":{"URL":"https:\/\/trialsjournal.biomedcentral.com\/articles\/10.1186\/s13063-023-07558-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,15]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["7558"],"URL":"https:\/\/doi.org\/10.1186\/s13063-023-07558-9","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-2097470\/v1","asserted-by":"object"}]},"ISSN":["1745-6215"],"issn-type":[{"value":"1745-6215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,15]]},"assertion":[{"value":"28 September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Research Ethics Committee of the Federal University of Santa Maria (process no. 3.208.982) and will be carried out in accordance with ethical criteria in research with human beings of the Resolution of the National Commission for Ethics in Research (n\u00ba 466\/12), National Health Council\/Ministry of Health, and other Brazilian Ethical Resolutions. All subjects will provide written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate\u00a0{24}"}},{"value":"Not applicable\u2014no identifying images or other personal or clinical details of participants are presented here or will be presented in reports of the trial results. The participant information materials and informed consent form are available from the corresponding author on request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication {32}"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests {28}"}}],"article-number":"532"}}