The mediating effect of dyspnea belief between fatigue degree and perceived exercise behavior in patients with chronic obstructive pulmonary disease
-
摘要:
目的 慢性阻塞性肺疾病(COPD)患者普遍存在锻炼行为不足的问题。为探索影响患者锻炼行为的内在心理机制，本研究对呼吸困难信念在COPD患者疲劳程度与锻炼行为感知间的关系进行分析，旨在为制定针对COPD患者的有效干预策略提供理论依据。 方法 选取2024年1月—2025年7月温州医科大学附属第一医院呼吸与危重症医学科收治的215例COPD患者, 剔除无效问卷，最终纳入203例。采用呼吸困难信念问卷(BBQ)、疲劳严重程度量表(FSS)、锻炼益处及障碍量表(EBBS)进行评估。采用Pearson相关性分析与SPSS 30.0统计学软件分析相关性及中介效应。 结果 COPD患者BBQ、FSS、EBBS评分分别为(36.90±5.06)分、(38.52±2.76)分、(116.45±14.68)分。EBBS评分与FSS、BBQ评分呈负相关关系，BBQ评分与FSS评分呈正相关关系。疲劳程度可负向预测锻炼行为感知水平，正向预测呼吸困难信念，增加中介变量呼吸困难信念后，疲劳程度、呼吸困难信念对锻炼行为感知水平有负向预测作用。呼吸困难信念在COPD患者疲劳程度与锻炼行为感知水平间的中介效应占比为36.43%。 结论 疲劳程度既可以直接降低COPD患者锻炼行为感知水平，又可以通过增强呼吸困难信念间接降低锻炼行为感知水平。减轻疲劳程度、降低呼吸困难信念可能是提高COPD患者锻炼行为感知水平的重要措施。 Abstract:Objective Patients with chronic obstructive pulmonary disease (COPD) commonly exhibit insufficient exercise behavior. To explore the intrinsic psychological mechanisms influencing patients ' exercise behaviors, this study analyzed the relationship between dyspnea belief and the perception of fatigue and exercise behaviors in COPD patients, aiming to provide a theoretical basis for formulating effective intervention strategies for this population. Methods A total of 215 COPD patients admitted to the Department of Respiratory and Critical Care Medicine at the First Affiliated Hospital of Wenzhou Medical University from January 2024 to July 2025 were selected for this study. After excluding invalid questionnaires, a final total of 203 cases were included. Assessments were conducted using the beliefs about breathlessness questionnaire (BBQ), the fatigue severity scale (FSS), and the exercise benefits/barriers scale (EBBS). The Pearson correlation coefficient and SPSS 30.0 statistical software were employed to analyze correlations and mediating effects. Results The BBQ, FSS, and EBBS scores of COPD patients were (36.90±5.06) points, (38.52±2.76) points, and (116.45±14.68) points, respectively. The EBBS score was negatively correlated with the FSS and BBQ scores, while the BBQ score was positively correlated with the FSS score. Fatigue degree could negatively predict the perceived level of exercise behavior and positively predict the dyspnea belief. After adding the mediating variable of the dyspnea belief, fatigue degree, and the dyspnea belief had a negative predictive effect on the perceived level of exercise behavior. The mediating effect of the dyspnea belief between the fatigue degree and the perceived level of exercise behavior in COPD patients accounted for 36.43%. Conclusion The degree of fatigue can not only directly reduce the perceived level of exercise behavior in COPD patients, but also indirectly reduce the perceived level of exercise behavior by enhancing the dyspnea belief. Reducing the degree of fatigue and lowering dyspnea belief may become important measures to improve the perceived level of exercise behavior in patients with COPD. -
表 1 EBBS评分条目
Table 1. EBBS Scoring Items
分量表 维度 条目数 计分方式与含义 总分与意义 锻炼益处 身体功能 11 正向计分： 29~116分：得分越高，感知到的锻炼益处越多 社会交往 4 1=非常不同意， 心理观念 6 2=不同意， 生命促进 5 3=同意， 预防保健 3 4=非常同意 锻炼障碍 锻炼环境 2 反向计分： 14~56分：得分越高，感知到的锻炼障碍越少 身心因素 5 1=非常同意， 家庭阻力 2 2=同意， 时间及开销 5 3=不同意， 4=非常不同意 
下载: 导出CSV
表 2 不同一般资料COPD患者EBBS评分比较(x±s, 分)
Table 2. Comparison of EBBS Scores for COPD patients with different general Information(x±s, points)
项目 例数 EBBS评分 统计量 P值 性别 1.190a 0.235 男性 159 115.76±15.87 女性 44 118.94±14.99 年龄 2.910a 0.004 ＜60岁 63 121.05±16.03 ≥60岁 140 114.38±14.68 BMI 0.142b 0.935 ＜18.5 28 114.96±17.02 18.5~24.0 86 117.06±15.53 ＞24.0~28.0 61 116.51±14.49 ＞28.0 28 115.94±15.71 文化程度 3.632b 0.014 小学及以下 101 113.14±17.25 初中 62 117.89±15.72 中专或高中 23 120.72±14.89 大专及以上 17 125.09±15.17 婚姻状况 5.007a ＜0.001 已婚 142 119.62±13.29 离婚、未婚或丧偶 61 109.07±14.82 职业状态 0.539a 0.591 在职 23 118.12±16.07 退休或无业 180 116.24±15.72 居住地 1.328a 0.186 农村 95 118.03±15.43 城市 108 115.06±16.31 家庭人均月收入 0.597b 0.551 ＜1 000元 60 115.02±15.11 1 000~3 000元 85 116.39±14.72 ＞3 000元 58 118.02±15.03 COPD病程 0.083b 0.920 ＜3年 57 115.82±15.27 3~5年 104 116.57±14.81 ＞5年 42 117.01±15.06 合并冠心病 0.463a 0.644 是 56 117.23±15.18 否 147 116.15±14.72 合并高血压 1.199a 0.232 是 79 118.01±15.64 否 124 115.45±14.29 合并糖尿病 0.665a 0.507 是 41 117.85±14.99 否 162 116.10±15.07 近2年急性加重次数 3.557a 0.001 ＜3次 160 118.42±15.34 ≥3次 43 109.12±14.76 呼吸困难程度 4.261a ＜0.001 ＜2级 156 119.03±16.04 ≥2级 47 107.89±14.55 氧疗 3.252a 0.001 是 42 123.36±14.31 否 161 114.65±15.74 患COPD前每天活动 5.018a ＜0.001 是 110 121.06±14.76 否 93 111.00±13.58 曾被告知锻炼的益处 5.008a ＜0.001 是 129 120.37±15.02 否 74 109.62±14.18 注：a为t值，b为F值。
下载: 导出CSV
表 3 COPD患者锻炼行为感知水平的影响因素分析
Table 3. Influencing factors of perceived level of exercise behavior in COPD patients
变量 模型1 β SE β' t值 P值 年龄 -0.376 0.245 -0.359 -1.535 0.064 文化程度 0.369 0.242 0.347 1.525 0.065 婚姻状况 -0.430 0.214 -0.418 -2.009 0.045 近2年急性加重次数 -0.415 0.198 -0.406 -2.096 0.040 呼吸困难程度 -0.427 0.204 -0.413 -2.093 0.040 氧疗 0.409 0.201 0.402 2.035 0.043 患COPD前每天活动 0.446 0.207 0.429 2.155 0.036 曾被告知锻炼的益处 0.436 0.210 0.430 2.076 0.041 变量 模型2 β SE β' t值 P值 年龄 -0.347 0.250 -0.323 -1.388 0.077 文化程度 0.332 0.254 0.319 1.307 0.081 婚姻状况 -0.407 0.186 -0.384 -2.188 0.035 近2年急性加重次数 -0.385 0.182 -0.371 -2.115 0.036 呼吸困难程度 -0.398 0.191 -0.349 -2.084 0.038 氧疗 0.385 0.245 0.368 1.571 0.061 患COPD前每天活动 0.458 0.226 0.412 2.027 0.041 曾被告知锻炼的益处 0.429 0.207 0.398 2.072 0.038 BBQ评分 -0.441 0.184 -0.425 -2.397 0.030 变量 模型3 β SE β' t值 P值 年龄 -0.336 0.252 -0.320 -1.333 0.085 文化程度 0.329 0.255 0.315 1.290 0.091 婚姻状况 -0.402 0.189 -0.360 -2.127 0.038 近2年急性加重次数 -0.369 0.242 -0.344 -1.525 0.068 呼吸困难程度 -0.361 0.163 -0.337 -2.215 0.033 氧疗 0.346 0.246 0.327 1.407 0.078 患COPD前每天活动 0.402 0.174 0.380 2.310 0.029 曾被告知锻炼的益处 0.403 0.183 0.383 2.202 0.035 BBQ评分 -0.426 0.212 -0.415 -2.009 0.045 FSS评分 -0.450 0.201 0.434 -2.239 0.031 注：模型1，R2=0.489，调整后R2=0.481，F=9.258，P＜0.001；模型2，R2=0.532，调整后R2=0.521，F=16.997，P＜0.001；模型3，R2=0.662，调整后R2=0.641，F=22.893，P＜0.001。
下载: 导出CSV
表 4 COPD患者呼吸困难信念在疲劳程度与锻炼行为感知水平间的中介效应
Table 4. Mediating effect of dyspnea belief in COPD patients between fatigue degree and perceived level of exercise behavior
结果变量 预测变量 拟合指标 系数显著性 R2 调整R2 F值 β t值 P值 锻炼行为感知水平 0.334 0.329 11.259 疲劳程度 -0.528 4.011 ＜0.001 呼吸困难信念 0.240 0.223 6.705 疲劳程度 0.141 2.446 0.028 锻炼行为感知水平 0.423 0.417 20.004 呼吸困难信念 -0.442 4.023 ＜0.001 疲劳程度 -0.318 3.284 0.009
下载: 导出CSV
表 5 COPD患者呼吸困难信念在疲劳程度与锻炼行为感知水平间的中介效应检验结果
Table 5. Test results of the mediating effect of belief in dyspnea between fatigue degree and perceived level of exercise behavior in COPD patients
效应 效应值 SE 95% CI 效应值占比(%) 总效应 -0.387 0.041 -0.242~-0.619 直接效应：疲劳程度→锻炼行为感知水平 -0.528 0.038 -0.301~-0.926 63.57 间接效应：疲劳程度→呼吸困难信念→锻炼行为感知水平 0.141 0.037 0.052~0.382 36.43
下载: 导出CSV
-
[1] ZOAKA L, AL-ZOUBEIDI Z, KHOKHAR S, et al. Acute methaemoglobinaemia as an overlooked cause of acute dyspnoea in a patient with chronic obstructive pulmonary disorder in the emergency department[J]. Cureus, 2025, 17(9): e92259. DOI: 10.7759/cureus.92259. [2] 黄其东, 郑雷雷, 张其霞, 等. ICU护士呼吸机相关性肺炎预防措施知信行及影响因素调查[J]. 中华全科医学, 2024, 22(5): 863-866. doi: 10.16766/j.cnki.issn.1674-4152.003521HUANG Q D, ZHENG L L, ZHANG Q X, et al. Investigation of knowledge, attitudes, and behaviors regarding ventilator-associated pneumonia prevention measures and influencing factors among ICU nurses[J]. Chinese Journal of General Practice, 2024, 22(5): 863-866. doi: 10.16766/j.cnki.issn.1674-4152.003521 [3] 王晶晶, 白晨晓, 张泽懿, 等. 老年慢性阻塞性肺疾病患者锻炼行为感知现状及影响因素分析[J]. 中华护理杂志, 2022, 57(1): 36-42.WANG J J, BAI C X, ZHANG Z Y, et al. The current status of exercise perception and its influencing factors in elderly patients with chronic ob-structive pulmonary disease[J]. Chinese Journal of Nursing, 2022, 57(1): 36-42. [4] 刘艳芳, 刘艳芹, 张俊霞, 等. 慢性阻塞性肺疾病患者体力活动的变化轨迹及影响因素[J]. 海南医学, 2025, 36(7): 1038-1043.LIU Y F, LIU Y Q, ZHANG J X, et al. Trajectories and influencing factors of physical activity in patients with chronic obstructive pulmonary disease[J]. Hainan Medical Journal, 2025, 36(7): 1038-1043. [5] 杨斌, 叶青, 王志勇, 等. 社区老年人群体力活动水平与疲劳之间的相关性研究[J]. 东南大学学报(医学版), 2025, 44(2): 197-205.YANG B, YE Q, WANG Z Y, et al. Association between physical activity levels and fatigue among community-dwelling older adults[J]. Journal of Southeast University (Medical Science), 2025, 44(2): 197-205. [6] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 170-205.Chronic obstructive pulmonary disease group of the respiratory disease branch of the chinese medical association, Chronic obstructive pulmonary disease working committee of the respiratory physician branch of the chinese medical doctor association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease (revised version 2021)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(3): 170-205. [7] DE PEUTER S, JANSSENS T, VAN DIEST I, et al. Dyspnea-related anxiety: the Dutch version of the breathlessness beliefs questionnaire[J]. Chron Respir Dis, 2011, 8(1): 11-19. doi: 10.1177/1479972310383592 [8] KRUPP L B, LAROCCA N G, MUIR-NASH J, et al. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus[J]. Arch Neurol, 1989, 46(10): 1121-1123. doi: 10.1001/archneur.1989.00520460115022 [9] SECHRIST K R, WALKER S N, PENDER N J. Development and psychometric evaluation of the exercise benefits/barriers scale[J]. Res Nurs Health, 1987, 10(6): 357-365. doi: 10.1002/nur.4770100603 [10] RICHARDS J B. Calculated decisions: mMRC (modified Medical Research Council) dyspnea scale[J]. Emerg Med Pract, 2017, 19(Suppl 10): 1-2. [11] LIAO Y, YU J, ZHAN Y, et al. Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: a qualitative study applying the motivation, opportunity, and ability model[J]. PLoS One, 2024, 19(5): e0303858. DOI: 10.1371/journal.pone.0303858. [12] 郑雨霖, 金雪文, 陈坤伦, 等. 炎症反应与COPD伴呼吸衰竭住院患者短期再入院的关系[J]. 新医学, 2024, 55(8): 631-640.ZHENG Y L, JIN X W, CHEN K L, et al. The relationship between inflammatory response and short-term readmission in hospitalized patients with COPD accompanied by respiratory failure[J]. New Medicine, 2024, 55(8): 631-640. [13] ALJAMA C, GRANADOS G, RAMON M, et al. Motivation and confidence about physical activity in chronic obstructive pulmonary disease patients: health benefits matter to patients[J]. Respiration, 2024, 103(7): 378-387. doi: 10.1159/000539206 [14] PENG L C, XU M, WANG Y, et al. Latent profile analysis of dyspnea-related kinesiophobia in older adults with chronic obstructive pulmonary disease[J]. Heart Lung, 2025, 69(1): 241-247. [15] 张丹, 齐宏波, 安欣, 等. 叙事护理对慢性阻塞性肺疾病患者呼吸困难信念的干预研究[J]. 实用临床医药杂志, 2023, 27(1): 115-119.ZHANG D, QI H B, AN X, et al. Intervention Study of Narrative Nursing on the Belief of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease[J]. Journal of Clinical Medicine in Practice, 2023, 27(1): 115-119. [16] JIANG Z, LI H, YU L, et al. The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: a moderated mediation model[J]. Sci Rep, 2025, 15(1): 9190. DOI: 10.1038/s41598-025-94108-9. [17] WANG J, BAI C, ZHANG Z, et al. The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: cross-sectional survey and mediated moderation analysis[J]. Heart Lung, 2023, 59(1): 95-101. [18] 茹运新, 来李鑫, 梁发存, 等. 慢性阻塞性肺疾病患者疲劳风险列线图模型的构建及验证[J]. 中华护理杂志, 2024, 59(13): 1584-1591.RU Y X, LAI L X, LIANG F C, et al. Construction and validation of a fatigue risk nomogram model in patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2024, 59(13): 1584-1591. [19] 金姣姣, 王姗姗, 陈怡, 等. 老年卵巢癌患者居家锻炼行为感知现状及影响因素分析[J]. 中国实用护理杂志, 2025, 41(1): 49-55.JIN J J, WANG S S, CHEN Y, et al. Analysis of the Perceived status and Influencing Factors of Home-based Exercise Behavior in Elderly Patients with Ovarian cancer[J]. Chinese Journal of Practical Nursing, 2025, 41(1): 49-55. [20] BLONDEEL A, HERMANS F, BREULS S, et al. Factors associated to physical activity in patients with COPD: an ecological approach[J]. Respir Med, 2023, 219: 107424. DOI: 10.1016/j.rmed.2023.107424. [21] 赵毛妮, 席芳, 杨杰, 等. COPD患者呼吸困难信念现状及影响因素分析[J]. 中华现代护理杂志, 2022, 28(18): 2412-2416.ZHAO M N, XI F, YANG J, et al. Analysis of the current Situation and Influencing factors of dyspnea beliefs in COPD patients[J]. Chinese Journal of Modern Nursing, 2022, 28(18): 2412-2416. -
点击查看大图
表(5)
计量
- 文章访问数: 11
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
