Exploring Dyspnea-Related Anxiety and Physical Activity in Older US Veterans With COPD

TL;DR

This study explores how anxiety about breathlessness affects physical activity in older veterans with COPD, finding that breathlessness severity fully explains the relationship.

Contribution

The study is the first to examine the mediating role of dyspnea severity in the relationship between dyspnea-specific anxiety and physical activity in COPD patients.

Findings

Dyspnea severity fully mediated the relationship between dyspnea-related anxiety and physical activity.

Higher dyspnea-related anxiety was associated with lower physical activity when accounting for dyspnea severity.

The study highlights the need for longitudinal research on dyspnea-specific anxiety and physical activity in COPD patients.

Abstract

Dyspnea is a debilitating symptom in persons with chronic obstructive pulmonary disease (COPD) and has been linked to both activity restriction and psychological consequences, such as dyspnea-specific anxiety symptoms (e.g., fear of dyspnea or fear of dyspnea-inducing activities). To date, however, the association between dyspnea severity, objectively measured physical activity (PA), and dyspnea-specific anxiety symptoms has not been explored. In this study, we hypothesized that higher dyspnea-related anxiety (assessed via Breathlessness Beliefs Questionnaire-BBQ) would be associated with reduced PA (assessed via accelerometer-derived step counts), and that dyspnea severity (assessed via the University of California, San Diego Shortness of Breath Questionnaire) would mediate the relationship between dyspnea-related anxiety and PA. Forty-two Veterans were recruited (88% white, 93% male) with a mean age of 69 +/- 6 years, mean FEV1 67 +/- 21%, and mean daily step count (averaged over 14 +/- 1 days) of 4635 +/- 2115 steps. PA and BBQ scores were significantly correlated (r = -0.38, p = .014). Simple mediation analysis demonstrated a significant indirect effect of BBQ scores on PA through dyspnea severity (point estimate = -0.26, 95% CI = [-0.43, -0.11]). After accounting for indirect effects, there was no significant main effect of BBQ scores on PA (β = -0.12, p = .44), suggesting dyspnea levels completely mediated the relationship between BBQ scores and PA. Although the direction of relationship between these variables cannot be determined using cross-sectional data, this exploratory study suggests the need for longitudinal studies examining dyspnea-specific anxiety and PA in this population.