Yeh Gloria Y, Mu Lin, Davis Roger B, Wayne Peter M
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, Massachusetts (Drs Yeh and Davis and Ms Mu); and Osher Center for Integrative Medicine, Harvard Medical School (Dr Wayne) and Division of Preventive Medicine, Brigham and Women's Hospital (Dr Wayne), Boston, Massachusetts.
J Cardiopulm Rehabil Prev. 2016 May-Jun;36(3):186-94. doi: 10.1097/HCR.0000000000000170.
Exercise self-efficacy is one of the strongest predictors of physical activity behavior. Prior literature suggests that tai chi, a mind-body exercise, may increase self-efficacy; however, this is not extensively studied. Little is known about the factors associated with development of exercise self-efficacy in a population with heart failure.
We utilized data from a randomized controlled trial of 12 weeks of group tai chi classes versus education in patients with chronic heart failure (n = 100). Multivariable linear regression was used to explore possible correlates of change in exercise self-efficacy in the entire sample and in the subgroup who received tai chi (n = 50). Covariates included baseline quality of life, social support, functional parameters, physical activity, serum biomarkers, sociodemographics, and clinical heart failure parameters.
Baseline 6-minute walk (β=-0.0003, SE = 0.0001, P = .02) and fatigue score (β= 0.03, SE = 0.01, P = .004) were significantly associated with change in self-efficacy, with those in the lowest tertile for 6-minute walk and higher tertiles for fatigue score experiencing the greatest change. Intervention group assignment was highly significant, with self-efficacy significantly improved in the tai chi group compared to the education control over 12 weeks (β= 0.39, SE = 0.11, P < .001). In the tai chi group alone, lower baseline oxygen uptake (β=-0.05, SE = 0.01, P = .001), decreased mood (β=-0.01, SE = 0.003, P = .004), and higher catecholamine level (epinephrine β= 0.003, SE = 0.001, P = .005) were significantly associated with improvements in self-efficacy.
In this exploratory analysis, our initial findings support the concept that interventions like tai chi may be beneficial in improving exercise self-efficacy, especially in patients with heart failure who are deconditioned, with lower functional status and mood.
运动自我效能是身体活动行为最强的预测因素之一。既往文献表明，太极拳这种身心锻炼方式可能会提高自我效能；然而，对此尚未进行广泛研究。对于心力衰竭患者群体中与运动自我效能发展相关的因素知之甚少。
我们利用了一项针对100例慢性心力衰竭患者的随机对照试验的数据，该试验将为期12周的团体太极拳课程与健康教育进行对比。采用多变量线性回归分析来探究整个样本以及接受太极拳课程的亚组（n = 50）中运动自我效能变化的可能相关因素。协变量包括基线生活质量、社会支持、功能参数、身体活动、血清生物标志物、社会人口统计学以及临床心力衰竭参数。
基线6分钟步行距离（β=-0.0003，标准误 = 0.0001，P = .02）和疲劳评分（β= 0.03，标准误 = 0.01，P = .004）与自我效能的变化显著相关，6分钟步行距离处于最低三分位数且疲劳评分处于较高三分位数的患者自我效能变化最大。干预组分配具有高度显著性，与健康教育对照组相比，太极拳组在12周内自我效能显著提高（β= 0.39，标准误 = 0.11，P < .001）。仅在太极拳组中，较低的基线摄氧量（β=-0.05，标准误 = 0.01，P = .001）、情绪低落（β=-0.01，标准误 = 0.003，P = .004）以及较高的儿茶酚胺水平（肾上腺素β= 0.003，标准误 = 0.001，P = .005）与自我效能的改善显著相关。
在这项探索性分析中，我们的初步研究结果支持这样的观点，即太极拳等干预措施可能有助于提高运动自我效能，尤其是对于身体状况不佳、功能状态和情绪较低的心力衰竭患者。
