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

doi:10.3761/j.issn.0254-1769.2022.01.005

摘要/Abstract

摘要：

目的评估老年慢性阻塞性肺疾病 (chronic obstructive pulmonary disease,COPD) 患者锻炼行为感知水平,并分析其影响因素。方法采用方便抽样法,选取2018年12月—2019年6月于济南市4所三级甲等医院住院的207例老年COPD患者作为调查对象。采用一般资料调查表、锻炼益处及障碍量表、呼吸困难信念问卷、COPD患者自我效能量表和社会支持评定量表进行调查。结果 207例老年COPD患者锻炼益处及障碍量表得分为 (127.34±11.71) 分,锻炼行为感知与恐惧活动信念呈负相关 (r=-0.469,P<0.001),与自我效能和社会支持均呈正相关 (r=0.412,P<0.001;r=0.247,P<0.001) 。多元线性回归分析结果显示,恐惧活动信念、自我效能、社会支持及患病前体力活动情况是锻炼行为感知的影响因素。结论老年COPD患者的锻炼行为感知水平有待提高。加强对COPD患者及其家属的运动康复教育和指导,帮助患者消除或降低对体力活动的恐惧,提高自我效能感和获取、利用社会支持的能力,有利于改善其对锻炼行为的感知。

关键词: 老年人, 肺疾病,慢性阻塞性, 感知, 锻炼, 体力活动, 影响因素分析, 护理

Abstract:

Objective To assess the current status of exercise perception in elderly patients with chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors. Methods Using a convenience sampling method,207 hospitalized elderly COPD patients from 4 tertiary hospitals in Jinan city from December 2018 to June 2019 were selected as participants. The general information questionnaire,Exercise Benefit/Barriers Scale,Breathlessness Beliefs Questionnaire,Self-efficacy Scale and Social Support Rating Scale were used for investigation. Results The total score of exercise benefits/barriers in 207 elderly COPD patients was (127.34±11.71). Exercise perception was negatively correlated with activity-related fear (r=-0.469,P<0.001),and positively correlated with both self-efficacy and social support (r=0.412,P<0.001;r=0.247,P<0.001). Multiple linear regression analysis revealed that activity-related fear,self-efficacy,social support,and the situation of physical activity prior to COPD were the influlencing factors of exercise perception. Conclusion The level of exercise perception in elderly patients with COPD needs to be improved. Strengthening exercise rehabilitation education and guidance for COPD patients and their families,helping patients eliminate or reduce their fear of physical activity,and improving their self-efficacy and ability to access and utilize social support are beneficial to improve their exercise perception.

Key words: Aged, Pulmonary Disease,Chronic Obstructive, Perception, Exercise, Physical Activity, Root Cause Analysis, Nursing Care

王晶晶, 白晨晓, 张泽懿, 伊默, 贾元敏, 陈欧. 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): 36-41.

WANG Jingjing, BAI Chenxiao, ZHANG Zeyi, YI Mo, JIA Yuanmin, CHEN Ou. The current status of exercise perception and its influencing factors in elderly patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2022, 57(1): 36-41.

图/表 5

表1 老年慢性阻塞性肺疾病患者的一般资料及锻炼行为感知影响因素的单因素分析结果 (n=207)

Table 1 The general data of subjects and univariate analysis of exercise perception for elderly patients with chronic obstructive pulmonary disease (n=207)

表2 老年慢性阻塞性肺疾病患者在锻炼益处和锻炼障碍维度中选择同意及非常同意的比例位于前5位的条目 (n=207)

Table 2 The five items with the highest proportion of agree and strongly agree were selected for exercise benefits dimension and exercise barriers dimension in elderly patients with chronic obstructive pulmonary disease (n=207)

表3 老年慢性阻塞性肺疾病患者锻炼行为感知、恐惧活动信念、自我效能、社会支持的相关性分析结果 (n=207,r 值)

Table 3 Correlation analysis of exercise perception,activity-related fear,self-efficacy and social support in elderly patients with chronic obstructive pulmonary disease (n=207, r value)

表4 分类变量赋值方式

Table 4 Categorical variable assignment method

表5 老年慢性阻塞性肺疾病患者锻炼行为感知影响因素的多元线性回归分析结果 (n=207)

Table 5 Results of multiple linear regression analysis of factors influencing exercise perception in elderly patients with chronic obstructive pulmonary disease (n=207)

参考文献 28

[1]	Wang C, Xu JY, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China(the China Pulmonary Health[CPH] study):a national cross-sectional study[J]. Lan-cet, 2018, 391(10131):1706-1717.
[2]	World Health Organization. Physical activity[EB/OL].(2020-11-26)[2020-12-25]. https://www.who.int/news-room/fact-sheets/detail/physical-activity.
[3]	Fuertes E, Carsin AE, Antó JM, et al. Leisure-time vigorous physical activity is associated with better lung function:the prospective ECRHS study[J]. Thorax, 2018, 73(4):376-384. DOI PMID
[4]	Demeyer H, Costilla-Frias M, Louvaris Z, et al. Both moderate and severe exacerbations accelerate physical activity decline in COPD patients[J]. Eur Respir J, 2018, 51(1):1702110. DOI URL
[5]	Sievi NA, Brack T, Brutsche MH, et al. Physical activity declines in COPD while exercise capacity remains stable:a longitudinal study over 5 years[J]. Respir Med, 2018, 141:1-6. DOI URL
[6]	Pender NJ, Walker SN, Sechrist KR, et al. Development and testing of the health promotion model[J]. Cardiovasc Nurs, 1988, 24(6):41-43. PMID
[7]	Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease 2018 report[EB/OL]. (2017-11-15)[2020-12-25]. http://www.goldcoped.org.
[8]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)[J]. 中国医学前沿杂志(电子版), 2014, 6(2):67-80.
	Chronic Obstructive Pulmonary Group, Respiratory Branch, Chinese Medical Association. Guideline for diagnosis and treatment of chronic obstructive pulmonary disease(2013 revision)[J]. Chin J Frontiers of Med(Electronic Edition), 2014, 6(2):67-80.
[9]	Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the Exercise Benefits/Barriers Scale[J]. Res Nurs Health, 1987, 10(6):357-365. PMID
[10]	郑晶. 维持性血液透析患者体力活动及其影响因素[D]. 广州:中山大学, 2009.
	Zheng J. Physical activity and correlation in maintenance hemodialysis patients[D]. Guangzhou:Sun Yat-sen University, 2009.
[11]	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 URL
[12]	伍青. 慢性阻塞性肺疾病患者呼吸困难信念及其对功能状态影响的研究[D]. 北京:中国医学科学院北京协和医学院, 2015.
	Wu Q. Breathlessness beliefs and its effect on functional status in patients with chronic obstructive pulmonary disease[D]. Beijing:Peking Union Medical University,Chinese Academy of Medical Sciences, 2015.
[13]	Wong KW, Wong FK, Chan MF. Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease[J]. J Adv Nurs, 2005, 49(2):210-222. DOI URL
[14]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2):98-100.
	Xiao SY. The theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychol Med, 1994, 4(2):98-100.
[15]	杨凡, 潘越, 邹泽宇. 中国老年人体育锻炼状况及影响因素研究[J]. 中国体育科技, 2019, 55(10):10-21,40.
	Yang F, Pan Y, Zou ZY. Patterns and determinants of physical activity of elderly people in China[J]. China Sport Sci Technol, 2019, 55(10):10-21,40.
[16]	张利峰, 张美芬, 肖萍, 等. 老年全髋关节置换术后患者的康复锻炼自我效能及其相关因素的研究[J]. 护理管理杂志, 2017, 17(10):717-719.
	Zhang LF, Zhang MF, Xiao P, et al. Study on self-efficacy and related factors of rehabilitation exercise in elderly patients after total hip replacement[J]. J Nurs Adm, 2017, 17(10):717-719.
[17]	Matson TE, Anderson ML, Renz AD, et al. Changes in self-reported health and psychosocial outcomes in older adults enrolled in sedentary behavior intervention study[J]. Am J Health Promot, 2019, 33(7):1053-1057. DOI URL
[18]	Wang HC, Tsai JC, Chao YF, et al. An exploration of beliefs regarding exercise among Taiwanese patients with chronic obstructive pulmonary disease[J]. Heart Lung, 2013, 42(2):133-138. DOI URL
[19]	罗媛容, 陈妙霞, 吴少珠, 等. 慢性阻塞性肺疾病患者日常体力活动影响因素的质性研究[J]. 中国全科医学, 2020, 23(21):2635-2641. DOI
	Luo YR, Chen MX, Wu SZ, et al. Daily physical activity in patients living with COPD:a qualitative study[J]. Chin Gen Pract, 2020, 23(21):2635-2641.
[20]	王秀秀, 蒋玉宇, 王姗姗, 等. 慢性阻塞性肺疾病患者肺康复体验的质性研究[J]. 中华护理杂志, 2020, 55(5):696-702.
	Wang XX, Jiang YY, Wang SS, et al. A qualitative study on coping strategies of pulmonary rehabilitation barriers in patients with chronic obstructive pulmonary disease[J]. Chin J Nurs, 2020, 55(5):696-702.
[21]	朱建俊, 陆洪国, 胡志伟, 等. 呼吸困难信念对老年慢性阻塞性肺疾病患者功能状态的影响[J]. 中国慢性病预防与控制, 2017, 25(6):453-456.
	Zhu JJ, Lu HG, Hu ZW, et al. Effect of breathlessness beliefs on functional status in elderly patients with COPD[J]. Chin J Prev Control Chronic Dis, 2017, 25(6):453-456.
[22]	Hoaas H, Andreassen HK, Lien LA, et al. Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease:a mixed methods study[J]. BMC Med Inform Decis Mak, 2016, 16:26. DOI URL
[23]	DePew ZS, Garofoli AC, Novotny PJ, et al. Screening for severe physical inactivity in chronic obstructive pulmonary disease：the value of simple measures and the validation of two physical activity questionnaires[J]. Chron Respir Dis, 2013, 10(1):19-27. DOI URL
[24]	Darawad MW, Khalil AA, Hamdan-Mansour AM, et al. Perceived exercise self-efficacy,benefits and barriers,and commitment to a plan for exercise among Jordanians with chronic illnesses[J]. Rehabil Nurs, 2016, 41(6):342-351. DOI URL
[25]	Meshe OF, Bungay H, Claydon LS. Participants’ experiences of the benefits,barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease[J]. Health Soc Care Community, 2020, 28(3):969-978. DOI URL
[26]	Dinges NG, Joos SK. Stress,coping,and health:models of interaction for Indian and native populations[J]. Am Indian Alsk Native Ment Health Res Monogr Ser, 1988, 1:8-64. PMID
[27]	张义静, 李娟, 孙丽, 等. 慢性阻塞性肺疾病患者早期简易肺康复方案的构建及应用[J]. 中华护理杂志, 2020, 55(5):690-695.
	Zhang YJ, Li J, Sun L, et al. Construction of an early simple pulmonary rehabilitation programme for patients with COPD and its evaluation of effectiveness[J]. Chin J Nurs, 2020, 55(5):690-695.
[28]	郭燕红. 实施健康中国战略推动护理事业发展[J]. 中华护理杂志, 2018, 53(1):5.
	Guo YH. Implementing Healthy China strategy and promoting nursing development[J]. Chin J Nurs, 2018, 53(1):5.