Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, United States of America.
Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2021 Apr 8;16(4):e0249263. doi: 10.1371/journal.pone.0249263. eCollection 2021.
Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control.
We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached.
A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains.
Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD.
This trial is registered in Clinical Trials.gov, ID number NCT01551953.
慢性阻塞性肺疾病（COPD）与多种心理社会和行为因素有关。先前的研究表明，身心干预可能支持健康行为的发展和维持，并改善此类患者的健康相关生活质量。我们旨在从定性的角度探讨与接受两种不同身心干预（与教育对照组相比）的 COPD 患者的认知、心理社会和行为变化。
我们分析了一项前瞻性、随机试点试验（N=123）的半结构化定性退出访谈，该试验调查了 12 周的太极拳（TC）与身心呼吸（MBB）与教育（EDU）对照组在中重度 COPD 患者中的情况。TC 涉及传统运动，将冥想呼吸融为一体，而 MBB 则主要侧重于冥想呼吸技术。访谈进行了录音并逐字记录。两名独立审查员使用迭代过程对随机选择的转录本进行定性分析，以确定扎根理论方法告知的新兴主题，直到达到主题饱和。
共审查了 66 份转录本（TC 组 N=22，MBB 组 N=22，EDU 组 N=22）。参与者的平均年龄为 68.1 岁，GOLD 阶段为 2.3，基线 FEV11%预计值平均值（SD）：58%（13.4），42.4%为女性。我们确定了六个经常提到的主题：1）整体意识和理解，2）自我护理知识、技能和行为，3）与行为相关的神经认知概念，4）身体功能，5）心理幸福感，6）社会支持/社会功能。与 EDU 相比，TC 和 MBB 组中有更多的参与者注意到自我意识和身心联系的提高（例如，身体和呼吸意识）、呼吸技术知识以及自我护理技能与日常活动的整合、对症状管理的自我效能（特别是管理焦虑和呼吸困难）、对疾病的接受程度、身体功能的改善（例如，耐力、呼吸困难、疲劳）和心理幸福感（特别是放松、情绪调节和减少反应性）。与 MBB 相比，TC 组的参与者更愿意继续进行自我护理行为、身体活动自我效能和提高灵活性。所有三组，包括 EDU，都注意到社会支持的增加和对疾病的了解。然而，EDU 组参与者较少提及与行为改变相关的过程，并且在神经认知、心理和身体功能领域的具体变化较少。
包括冥想呼吸在内的身心干预可能会影响与行为相关的神经认知和情绪因素，从而改善 COPD 患者的自我护理管理并支持积极的行为改变。
该试验在 ClinicalTrials.gov 注册，编号为 NCT01551953。
