ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1668157
This article is part of the Research TopicFundamentals and Advances in Cardiopulmonary RehabilitationView all 6 articles
Nonlinear Threshold Effects of Kinesiophobia on Exercise Adherence in older adults with COPD : A Segmented Regression Analysis
Provisionally accepted
- Sixth People's Hospital of Nantong, Nantong, China
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【Abstract】 Objective: To explore the threshold effect of kinesiophobia on exercise adherence in elderly patients with chronic obstructive pulmonary disease (COPD). Methods: A cross-sectional survey was conducted on 357 older adults with COPD were assessed using standardized questionnaires for general information, exercise adherence, and kinesiophobia (Tampa Scale for Kinesiophobia, TSK). Multiple linear regression identified independent factors affecting adherence. A restricted cubic spline model analyzed the nonlinear relationship between kinesiophobia and adherence. Results: The mean scores for exercise adherence and kinesiophobia were 30.9 ± 7.7 and 35.8 ± 10.7, respectively, with 59.9% of patients scoring above the clinical cutoff (>37) for significant kinesiophobia. Kinesiophobia (β = -0.51, p < 0.001), frequent hospitalizations (β = -0.25, p < 0.001), severe GOLD stage (β = -0.18, p < 0.001), and anxiety symptoms (β = -0.13, p = 0.001) were independent predictors of poorer adherence. A significant threshold effect was identified at a TSK score of 20. Below this threshold, kinesiophobia had no significant impact on adherence (β = -0.15, p=0.312); above it, adherence declined sharply with increasing fear (β = -0.89, p < 0.001). Conclusion: Exercise adherence was suboptimal in older adults with COPD, who demonstrated substantial kinesiophobia. A TSK score of 20 points serves as a critical threshold, recommending its use for early identification of high-risk patients. Clinical management should prioritize patients with TSK scores ≥20, frequent exacerbations, and comorbid anxiety for targeted interventions.
Keywords: older adults, COPD, Kinesiophobia, exercise adherence, Influencing factors, threshold effect
Received: 23 Jul 2025; Accepted: 15 Oct 2025.
Copyright: © 2025 Feng, Ji, Yang and Yao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Liang Yao, 2216314456@qq.com
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