{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:11:18Z","timestamp":1792131078040,"version":"4.4.0"},"reference-count":64,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T00:00:00Z","timestamp":1654905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The objective of this research is to assess the effects of seven different exercise therapies (aquatic exercise, aerobic exercise, yoga, Pilates, virtual reality exercise, whole-body vibration exercise, and resistance exercise) on the balance function and functional walking ability of multiple sclerosis disease patients. Materials and Methods: The effects of different exercise interventions on the balance function and functional walking ability in people with multiple sclerosis were assessed by searching five databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI; only randomized controlled trials were included. The included studies were assessed for risk of bias using the Cochrane assessment tool. Results: The RCTs were collected between the initial date of the electronic databases\u2019 creation and May 2022. We included 31 RCTs with 904 patients. The results of the collected data analysis showed that yoga can significantly improve patients\u2019 BBS scores (SUCRA = 79.7%) and that aquatic exercise can significantly decrease patients\u2019 TUG scores (SUCRA = 78.8%). Conclusion: Based on the network meta-analysis, we suggest that although each type of exercise is useful, yoga, virtual reality training, and aerobic training are more effective in improving the balance function of people with MS; aquatic exercise, virtual reality training, and aerobic training are more effective in improving the functional walking ability of people with MS.<\/jats:p>","DOI":"10.3390\/ijerph19127175","type":"journal-article","created":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T09:33:26Z","timestamp":1654940006000},"page":"7175","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Effects of Different Exercise Therapies on Balance Function and Functional Walking Ability in Multiple Sclerosis Disease Patients\u2014A Network Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4534-0469","authenticated-orcid":false,"given":"Zikang","family":"Hao","sequence":"first","affiliation":[{"name":"Department of Physical Education, Laoshan Campus, Ocean University of China, 238 Song Ling Rd., Qingdao 266100, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2606-338X","authenticated-orcid":false,"given":"Xiaodan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Laoshan Campus, Ocean University of China, 238 Song Ling Rd., Qingdao 266100, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Laoshan Campus, Ocean University of China, 238 Song Ling Rd., Qingdao 266100, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1056\/NEJMra1401483","article-title":"Multiple Sclerosis","volume":"378","author":"Reich","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"527","article-title":"Progressive multiple sclerosis: From pathogenic mechanisms to treatment","volume":"140","author":"Correale","year":"2017","journal-title":"Brain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/S0140-6736(16)31320-4","article-title":"Progressive multiple sclerosis: Prospects for disease therapy, repair, and restoration of function","volume":"389","author":"Ontaneda","year":"2017","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Freiha, J., Riachi, N., Chalah, M.A., Zoghaib, R., Ayache, S.S., and Ahdab, R. (2020). Paroxysmal Symptoms in Multiple Sclerosis\u2014A Review of the Literature. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103100"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/S0140-6736(16)30959-X","article-title":"Diagnosis of multiple sclerosis: Progress and challenges","volume":"389","author":"Brownlee","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dymecka, J., Gerymski, R., Tataruch, R., and Bidzan, M. (2022). Sense of Coherence and Health-Related Quality of Life in Patients with Multiple Sclerosis: The Role of Physical and Neurological Disability. J. Clin. Med., 11.","DOI":"10.3390\/jcm11061716"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/0308022617725492","article-title":"An exploration of fall-related, psychosocial variables in people with multiple sclerosis who have fallen","volume":"80","author":"Comber","year":"2017","journal-title":"Br. J. Occup. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/S1474-4422(17)30281-8","article-title":"Exercise in patients with multiple sclerosis","volume":"16","author":"Motl","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103791","DOI":"10.1016\/j.msard.2022.103791","article-title":"The effect of virtual reality-based therapy on fear of falling in multiple sclerosis: A systematic review and meta-analysis","volume":"63","author":"Akkan","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jbmt.2021.09.015","article-title":"The effectiveness of physical therapy interventions in reducing falls among people with multiple sclerosis: A systematic review and meta-analysis","volume":"29","author":"Abou","year":"2022","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.apmr.2021.08.008","article-title":"Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise","volume":"103","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1177\/1352458521996002","article-title":"Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis","volume":"27","author":"Harrison","year":"2021","journal-title":"Mult. Scler. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11739-016-1583-7","article-title":"Network meta-analysis: An introduction for clinicians","volume":"12","author":"Rouse","year":"2017","journal-title":"Intern. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The Timed up and Go\u2014A Test of Basic Functional Mobility for Frail Elderly Persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40520-017-0749-0","article-title":"Tools for assessing fall risk in the elderly: A systematic review and meta-analysis","volume":"30","author":"Park","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103128","DOI":"10.1016\/j.msard.2021.103128","article-title":"Effectiveness of Virtual Reality Rehabilitation in Persons with Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"54","author":"Nascimento","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ-Br. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/ijn.12252","article-title":"Risk of bias reporting in Cochrane systematic reviews","volume":"21","author":"Hopp","year":"2015","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chaimani, A., Higgins, J.P.T., Mavridis, D., Spyridonos, P., and Salanti, G. (2013). Graphical Tools for Network Meta-Analysis in STATA. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0076654"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/biomet\/asz002","article-title":"Multivariate output analysis for Markov chain Monte Carlo","volume":"106","author":"Vats","year":"2019","journal-title":"Biometrika"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101260","DOI":"10.1016\/j.ctcp.2020.101260","article-title":"Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease","volume":"41","author":"Marotta","year":"2020","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3233\/BMR-150515","article-title":"Different types of exercise in Multiple Sclerosis: Aerobic exercise or Pilates, a single-blind clinical study","volume":"30","author":"Kara","year":"2017","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jbmt.2020.11.003","article-title":"Effect of twelve weeks pilates training on functional balance of male patients with multiple sclerosis: Randomized controlled trial","volume":"25","author":"Gheitasi","year":"2021","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1589\/jpts.28.761","article-title":"Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: A randomized controlled trial","volume":"28","author":"Kara","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1177\/0269215516637202","article-title":"Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: A randomized controlled trial","volume":"31","author":"Kalron","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"383","DOI":"10.32598\/JRH.10.6.552.4","article-title":"The Effect of an Eight-week Pilates Training on Interleukine-18 Level, Fatigue, and Balance in Women With Multiple Sclerosis","volume":"10","author":"Asvar","year":"2020","journal-title":"J. Res. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.explore.2019.07.010","article-title":"The effects of Clinical Pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: A randomized controlled trial","volume":"16","author":"Ertekin","year":"2020","journal-title":"EXPLORE"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3233\/NRE-130957","article-title":"The effects of pilates on balance, mobility and strength in patients with multiple sclerosis","volume":"34","author":"Citaker","year":"2014","journal-title":"NeuroRehabilitation"},{"key":"ref_31","first-page":"143","article-title":"Effects of vibrotherapy on postural control, functionality and fatigue in multiple sclerosis patients: A randomised clinical trial","volume":"27","year":"2012","journal-title":"Neurology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1191\/0269215505cr919oa","article-title":"Effects of whole-body vibration in patients with multiple sclerosis: A pilot study","volume":"19","author":"Schuhfried","year":"2005","journal-title":"Clin. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"866","DOI":"10.2340\/16501977-0609","article-title":"Exploring the effects of a 20-week whole-body vibration training programme on leg muscle performance and function in persons with multiple sclerosis","volume":"42","author":"Broekmans","year":"2010","journal-title":"J. Rehabil. Med."},{"key":"ref_34","first-page":"684","article-title":"Influence of aquatic exercises in physical condition in patients with multiple sclerosis","volume":"58","author":"Aidar","year":"2018","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.apmr.2017.06.015","article-title":"Randomized Controlled Trial to Examine the Impact of Aquatic Exercise Training on Functional Capacity, Balance, and Perceptions of Fatigue in Female Patients With Multiple Sclerosis","volume":"99","author":"Kargarfard","year":"2018","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.apmr.2018.06.032","article-title":"The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis","volume":"100","author":"Young","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.explore.2016.06.005","article-title":"Yoga Training Has Positive Effects on Postural Balance and Its Influence on Activities of Daily Living in People with Multiple Sclerosis: A Pilot Study","volume":"12","author":"Tavares","year":"2016","journal-title":"EXPLORE"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Straudi, S., Martinuzzi, C., Pavarelli, C., Sabbagh Charabati, A., Benedetti, M.G., Foti, C., Bonato, M., Zancato, E., and Basaglia, N. (2014). A task-oriented circuit training in multiple sclerosis: A feasibility study. BMC Neurol., 14.","DOI":"10.1186\/1471-2377-14-124"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"449","DOI":"10.5812\/ircmj.3597","article-title":"Comparison of the Effect of 8 weeks Aerobic and Yoga Training on Ambulatory Function, Fatigue and Mood Status in MS Patients","volume":"15","author":"Ahmadi","year":"2013","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/PHM.0b013e3181d3e71f","article-title":"Cycling Progressive Resistance Training for People with Multiple Sclerosis: A Randomized Controlled Study","volume":"89","author":"Cakit","year":"2010","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1249\/MSS.0000000000001914","article-title":"Effect of High-Intensity Exercise on Multiple Sclerosis Function and Phosphorous Magnetic Resonance Spectroscopy Outcomes","volume":"51","author":"Orban","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Gervasoni, E., Cattaneo, D., and Jonsdottir, J. (2013). Effect of treadmill training on fatigue in multiple sclerosis: A pilot study. Int. J. Rehabil. Res. Int. Z. Rehabil. Rev. Int. Rech. Readapt., 37.","DOI":"10.1097\/MRR.0000000000000034"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1249\/MSS.0000000000002228","article-title":"Exercise Effects on Multiple Sclerosis Quality of Life and Clinical-Motor Symptoms","volume":"52","author":"Nagy","year":"2020","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_44","first-page":"389","article-title":"The effects of a treadmill training programme on balance, speed and endurance walking, fatigue and quality of life in people with multiple sclerosis","volume":"11","author":"Ahmadi","year":"2010","journal-title":"Int. SportMed J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1177\/1352458515620933","article-title":"The effects of robot-assisted gait training in progressive multiple sclerosis: A randomized controlled trial","volume":"22","author":"Straudi","year":"2016","journal-title":"Mult. Scler."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Moradi, M., Sahraian, M.A., Aghsaie, A., Kordi, M.R., Meysamie, A., Abolhasani, M., and Sobhani, V. (2015). Effects of Eight-week Resistance Training Program in Men With Multiple Sclerosis. Asian J. Sports Med., 6.","DOI":"10.5812\/asjsm.6(2)2015.22838"},{"key":"ref_47","first-page":"1127","article-title":"Effects of resistance training on the physical condition of people with multiple sclerosis","volume":"58","author":"Aidar","year":"2018","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1123\/jsr.2018-0303","article-title":"The Effect of Total Body Resistance Exercise on Mobility, Proprioception, and Muscle Strength of the Knee in People With Multiple Sclerosis","volume":"29","author":"Moghadasi","year":"2020","journal-title":"J. Sport Rehabil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"101902","DOI":"10.1016\/j.msard.2019.101902","article-title":"Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial","volume":"39","author":"Yazgan","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.apmr.2020.09.395","article-title":"Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial","volume":"102","author":"Molhemi","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"473","DOI":"10.3233\/NRE-182471","article-title":"The development and pilot evaluation of virtual reality balance scenarios in people with multiple sclerosis (MS): A feasibility study","volume":"43","author":"Khalil","year":"2018","journal-title":"NeuroRehabilitation"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1177\/1352458512472747","article-title":"The effect of Nintendo\u00ae Wii\u00ae on balance in people with multiple sclerosis: A pilot randomized control study","volume":"19","author":"Brichetto","year":"2013","journal-title":"Mult. Scler."},{"key":"ref_53","first-page":"e2933","article-title":"Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial","volume":"2","author":"Fardoun","year":"2014","journal-title":"JMIR Serious Games"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"van Aert, R.C.M., Wicherts, J.M., and van Assen, M.A.L.M. (2019). Publication bias examined in meta-analyses from psychology and medicine: A meta-meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215052"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"101529","DOI":"10.1016\/j.rehab.2021.101529","article-title":"Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews","volume":"65","author":"Momsen","year":"2022","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1089\/acm.2021.0003","article-title":"Yoga Interventions Used for the Rehabilitation of Stroke, Parkinson\u2019s Disease, and Multiple Sclerosis: A Scoping Review of Clinical Research","volume":"27","author":"Legault","year":"2021","journal-title":"J. Altern. Complement. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1089\/acm.2014.0091","article-title":"Hatha Yoga and Executive Function: A Systematic Review","volume":"22","author":"Luu","year":"2016","journal-title":"J. Altern. Complement. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0269215518793481","article-title":"Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: A prospective cohort study","volume":"33","author":"Quinn","year":"2019","journal-title":"Clin. Rehabil."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"944","DOI":"10.23736\/S1973-9087.17.04570-1","article-title":"Efficacy of aquatic therapy for multiple sclerosis: A systematic review","volume":"53","author":"Corvillo","year":"2017","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"pzaa224","DOI":"10.1093\/ptj\/pzaa224","article-title":"Blood-Flow Restriction Training for a Person With Primary Progressive Multiple Sclerosis: A Case Report","volume":"101","author":"Cohen","year":"2021","journal-title":"Phys. Ther."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"102022","DOI":"10.1016\/j.msard.2020.102022","article-title":"The effect of aquatic physical therapy on patients with multiple sclerosis: A systematic review and meta-analysis","volume":"41","author":"Amedoro","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"720","DOI":"10.3109\/09638288.2010.507855","article-title":"Community-based group aquatic programme for individuals with multiple sclerosis: A pilot study","volume":"33","author":"Salem","year":"2011","journal-title":"Disabil. Rehabil."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1002\/pmrj.12435","article-title":"Aquatic Therapy in Contemporary Neurorehabilitation: An Update","volume":"12","author":"Becker","year":"2020","journal-title":"PM&R"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3233\/JHD-140010","article-title":"Aquatherapy for neurodegenerative disorders","volume":"3","author":"Plecash","year":"2014","journal-title":"J. Huntingt. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7175\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:28:07Z","timestamp":1760138887000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/12\/7175"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,11]]},"references-count":64,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["ijerph19127175"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19127175","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,11]]}}}