The effect of cognition in combination with an ACBT on dyspnea-related kinesiophobia in patients with moderate to severe COPD: Non-randomized controlled trial

Abstract

Abstract Background The majority of patients with chronic obstructive pulmonary disease (COPD) have a catastrophic perception of dyspnea and avoid physical activity, with moderate to severe COPD patients exhibiting more pronounced kinesiophobia. The fear-avoidance model suggests that kinesiophobia can be alleviated by reducing dyspnea symptoms and altering the catastrophic perception of dyspnea as an illness. However, we discovered that single inspiratory muscle training and cognitive change have limitations. This study combined cognition and exercise to examine the efficacy of cognitive therapy based on social cognitive theory combined with an active cycle of breathing technique in reducing dyspnea-related kinesiophobia in patients with moderate to severe COPD. Methods This research involved 106 participants. The control group (N = 53) got standard nursing, whereas the intervention group (N = 53) received cognitive combined with active cycle of breathing technology intervention for 8 weeks. The breathlessness beliefs Questionnaire and other secondary outcomes were collected at baseline (T0) and 8 weeks after intervention (T2), and patients' breathlessness beliefs questionnaire were re-assessed at 4 weeks after intervention (T1) and 4 weeks after completion of all therapies (T3). Results The between-group effects, within-group effects, and interaction effect of BBQ, BBQ-SF, and BBQ-AA scores in the intervention group were statistically significant (P<0.05) when compared to the control group. The intervention group's six-minute walk distance was significantly higher than the control group's at the end of the 8-week intervention, and the intervention group's mMRC, BODE index, HADS total score and each dimension score, and CAT score were significantly lower than the control group's (P<0.05), and the differences between the two groups before and after the intervention were statistically significant (P<0.001). Only the difference in FEV1% score before and after intervention was statistically significant (P<0.001) in the pulmonary function index, whereas the changes in FVC, FEV1, and FEV1/FVC scores were not (P > 0.05). Conclusion The misconception of dyspnea in COPD patients served as the starting point for this study, which integrated cognitive and exercise training. The combined intervention substantially improved dyspnea-related kinesiophobia in patients with moderate to severe COPD, and the effect remained significant when the intervention duration was extended. Furthermore, it may enhance dyspnea and quality of life, increase exercise capacity, and lower the BODE index. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR2200058498, registered on 10/04/2022.