Comparison of Square-Stepping and Strengthening Exercises via Telerehabilitation in Individuals with COPD: A Randomised Trial

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a common, treatable condition causing respiratory symptoms and systemic effects. Physical activity can improve cognitive function in individuals with COPD, with Square-Stepping Exercise (SSE), a multitasking program combining cognitive and physical tasks, showing potential benefits. This study compares the effects of SSE and strengthening exercises (SE) on cognitive function and balance in individuals with COPD via telerehabilitation. Methods: This randomized clinical trial involved 34 male individuals with COPD divided into SSE and SE groups (n=17 each). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and balance was measured with the Biodex Balance System. Both interventions were conducted over 8 weeks through telerehabilitation. Results: Both groups showed significant improvement in cognitive function (p=0.01). However, the SSE group showed greater improvements in balance, particularly in the overall stability index and anterior/posterior stability index (p=0.014 and p=0.05). The SE group had minor improvements in specific balance parameters, such as the "eyes open, firm surface" condition (p=0.029). Although cognitive gains were similar between the groups, balance improvement was more pronounced in the SSE group. Conclusions: AThis randomized trial revealed that both SSE and SE, delivered via telerehabilitation, significantly improved cognitive function in individuals with COPD, with SSE offering superior balance enhancement. These findings suggest that multitasking exercises like SSE may have a synergistic effect on both cognitive and physical functions, reducing the risk of falls in individuals with COPD.