ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2026.
Volume 15.
Number 1 : 101-106 P-ISSN.
E-ISSN: 2302-2914
Current status and influencing factors analysis of respiratory function exercise adherence among middle-aged and elderly patients with chronic obstructive pulmonary disease in primary care settings Jixing Huang1.
Chao Liu2.
Yao Chen1* ABSTRACT Department of General Internal Medicine.
The People's Hospital of Gaoxian.
Yibin.
China Department of General Surgery.
Ach Medical University.
Ulaanbaatar.
Mongolia *Corresponding author:
Yao Chen.
Department of General Internal Medicine.
The People's Hospital of Gaoxian.
Yibin.
China.
18380445091@163.
Background: Chronic Obstructive Pulmonary Disease (COPD) seriously threatens the quality of life in middleaged and elderly populations.
Respiratory function exercise is a core non-pharmacological treatment, yet patient adherence is often suboptimal.
This study aimed to analyze the factors influencing adherence to respiratory function exercise among middle-aged and elderly COPD patients in primary care settings, providing a reference for clinical Methods: A cross sectional study that employs a total of 100 middle-aged and elderly COPD patients admitted to The People's Hospital of Gaoxian from February 2025 to January 2026 was selected.
All participants were hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
General demographic data were collected, and assessments were conducted using anxiety, depression, and social support scales.
Adherence to respiratory function exercise was also evaluated.
SPSSAU software was used for statistical analysis.
Univariate analysis employed the NA test, and multivariate analysis employed logistic regression.
Results: Among the 100 patients, 64 .
%) exhibited poor adherence, while 36 .
%) exhibited good adherence.
Multivariate logistic regression analysis revealed that age O70 years (OR=0.
, educational level of junior high school or below, disease duration <5 years, drug dependence, and anxiety were all risk factors for poor adherence to respiratory function exercise.
Conclusion: Adherence to respiratory function exercise in middle-aged and elderly COPD patients is associated with age, educational level, disease duration, drug dependence, and anxiety.
Clinical practice should address these factors with targeted measures to improve adherence and prognosis.
Received: 2026-01-19
Accepted: 2026-03-25
Published: 2026-04-24
INTRODUCTION
Chronic Obstructive Pulmonary Disease .
bbreviated as COPD), a prevalent chronic respiratory condition in clinical practice, has emerged as a significant global public health issue due to its high incidence, high disability rate, and substantial economic 1 The prevalence of COPD has shown a marked increase among middleaged and elderly populations, posing a severe threat to patientsAo daily quality of life and simultaneously imposing a heavy burden on families and society.
As a core Keywords: chronic obstructive pulmonary disease.
factor analysis.
middle-aged and elderly.
respiratory function Cite This Article: Huang.
Liu.
Chen.
Current status and influencing factors analysis of respiratory function exercise adherence among middle-aged and elderly patients with chronic obstructive pulmonary disease in primary care settings.
Bali Medical Journal 15.
: 101-106 DOI: 10.
15562/bmj.
component of non-pharmacological treatment for COPD, respiratory function exercise aims to improve patientsAo lung function, alleviate symptoms, enhance exercise tolerance, and improve quality of However, adherence to prescribed respiratory function exercises among middle-aged and elderly COPD patients is often influenced by various factors, leading to suboptimal exercise outcomes and affecting overall disease management.
Given the importance of adherence and the challenges faced, conducting an in- Bali Open Medical Journal 15.
: 101-106 | doi: 10.
15562/bmj.
depth analysis of the factors influencing adherence to respiratory function exercise and formulating effective interventions based on these findings are of great significance for improving treatment efficacy and quality of life in these 4Ae8 In light of this, this study aims to analyze the factors influencing adherence to respiratory function exercise among middle-aged and elderly COPD patients, in order to provide a scientific basis and practical guidance for improving patient adherence to these exercises.
ORIGINAL ARTICLE
METHODS
Study Population and Selection Criteria In this observational study, which employs a cross-sectional design, a total of 100 middle-aged and elderly patients with COPD admitted to Gaoxian PeopleAos Hospital between February 2025 and January 2026 were recruited as research The inclusion criteria required that participants met the established diagnostic criteria for COPD, were aged 45 years or older, were in a relatively stable phase of the disease, and possessed a normal mental state capable of effective Patients were excluded if they had experienced an acute exacerbation within the two weeks prior to the study, or if they presented with comorbid pulmonary diseases, acute infections, malignant tumors, autoimmune diseases, or limb dysfunction.
Data Collection and Demographic Variables General demographic and clinical data were extracted from existing admission records or collected via an in-hospital questionnaire, encompassing variables such as gender, age, education level, disease duration, the presence of hypertension or diabetes, drug dependence, and family Assessment of Psychological Status and Social Support Psychological status was evaluated using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), both of which consist of 20 items scored on a 4-point scale.
For both assessments, the total raw score was multiplied by 1.
and rounded to the nearest integer to yield a final score out of 100.
anxiety was defined by a score of 50 or higher, while depression was identified by a score of 53 or higher.
Furthermore, the level of social support was measured using the Social Support Rating Scale (SSRS), where a total score of less than 20 out of a maximum 40 points was categorized as low social support.
Evaluation of Adherence to Respiratory Function Exercise Adherence to respiratory function exercise was assessed using a dedicated scale covering four dimensions: understanding of respiratory exercise knowledge, correct execution of medical instructions, consistent scheduling of exercises, and completion of all exercise items.
Each dimension was allocated a maximum of 2 points, and a cumulative score of 4 or higher was utilized to define good adherence, whereas lower scores were classified as poor adherence.
Quality Control and Ethical Considerations To ensure the validity of the responses and minimize social desirability bias, all questionnaires were completed anonymously in the absence of medical Participants were explicitly informed that their data would be used solely for academic purposes and would not impact their clinical treatment, with all information managed under strict Statistical Analysis SPSSAU software was used for statistical analysis of the data.
Count data were described as Aunumber or proportion (%)Ay and analyzed using the NA test.
Measurement data conforming to a normal distribution were described as Aumean A standard deviation .
E A.
Ay and analyzed using the t-test.
if the distribution was skewed, non-parametric tests were With adherence to respiratory function exercise as the dependent variable and the general data collected above as independent variables, variables with statistically significant differences in the univariate analysis were included in a multivariate logistic regression to analyze the risk factors influencing adherence to respiratory function exercise.
P-value <0.
05 was considered statistically RESULTS Current Status of Adherence to Respiratory Function Exercise.
Among the 100 middle-aged and elderly COPD patients, 64 cases .
exhibited poor adherence, while 36 cases .
00%) exhibited good adherence to respiratory function exercise.
Univariate Analysis of Factors Influencing Adherence to Respiratory Function Exercise in Middle-aged and Elderly COPD Patients.
The univariate analysis revealed that educational level, disease duration, drug dependence, anxiety and depression status, and level of social support were associated with adherence to respiratory function exercise in COPD patients, with all differences being statistically significant (P values all <0.
See Table 1.
Multivariate Logistic Regression Analysis of Factors Influencing Adherence to Respiratory Function Exercise in Middle-aged and Elderly COPD Patients.
The multivariate logistic regression analysis revealed that an education level of junior high school or below, a disease duration of less than 5 years, drug dependence, the presence of anxiety, and age O70 years were all risk factors for poor adherence to respiratory function exercise in middle-aged and elderly COPD patients .
ll P values <0.
Table .
DISCUSSION
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung condition that predominantly affects middle-aged and elderly individuals.
While its exact pathogenesis has not been fully elucidated, it is considered to be associated with factors such as long-term smoking, recurrent respiratory infections, and air pollution.
Patients typically present with symptoms like chronic cough, sputum production, and dyspnea, which significantly impair daily life.
9 Respiratory function exercise is crucial for middleaged and elderly COPD patients, aiding in improving respiratory function, enhancing physical capacity, reducing the frequency of acute exacerbations, and elevating quality of life.
However, clinical studies indicate that adherence to respiratory function exercise among these patients is generally low, influenced by various factors, potentially leading to further deterioration of respiratory function and disease progression.
10 Therefore, it is clinically essential to identify the factors affecting adherence to respiratory function exercise in this population and implement Bali Medical Journal 2026.
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ORIGINAL ARTICLE
effective interventions accordingly to improve adherence and prognosis.
As a non-pharmacological treatment, respiratory function exercise requires patients to possess a certain level of disease knowledge and exercise techniques.
Patients with lower educational attainment may struggle to fully comprehend the Table 1.
importance and specific procedures of the exercises, thereby affecting their motivation and accuracy.
11 Concurrently, these patients may have less exposure to and use of modern informational tools such as the internet and e-books, limiting their access to disease-related knowledge and exercise guidance.
In contrast.
Univariate and bivariate analysis of factors influencing adherence to respiratory function exercise in middle-aged and elderly patients with COPD Variable Poor Adherence Group Good Adherence Group Gender Male Female Age Group .
<60 >70 Junior high or below High school or above <5 years Ou5 years Yes Yes Yes Education Level Disease Duration Comorbid Hypertension Comorbid Diabetes Drug Dependence Family History Yes Anxiety Status Present Absent Depression Status Present Absent Social Support Level High Low Note:*p<0,05 Bali Medical Journal 2026.
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<0.
<0.
patients with higher education levels are more likely to acquire the latest medical information and professional exercise guidance through various channels.
Furthermore, patients with lower education may hold less firm beliefs regarding health maintenance and disease They might lack sufficient awareness of the severity of COPD and understanding of the long-term benefits of respiratory function exercise.
This deficit in belief could lead to insufficient emphasis on exercise, ultimately impacting Previous studies indicated that adherence to respiratory muscle training among middle-aged and elderly COPD patients is generally low, which may be related to factors such as short disease duration, low educational level, negative emotions, and low social support.
12,13 This finding requires clinical attention and is consistent with the results of this study.
Patients with a shorter duration of COPD may not yet fully recognize the severity and chronicity of the disease.
They often lack an in-depth understanding of the pathophysiological process, disease progression, and the importance of respiratory function exercise in COPD This insufficient knowledge can lead to a lack of emphasis on exercise, thereby affecting adherence.
Additionally, in the early stages of the disease.
COPD symptoms are relatively mild and may not command enough As the disease progresses and symptoms worsen, patients may gradually become aware of the necessity of exercise.
Drug dependence may lead to physiological and psychological changes in middle-aged and elderly COPD patients, subsequently affecting their ability and motivation to perform respiratory function exercises.
For instance, certain medications may cause side effects such as sedation or drowsiness, reducing patient alertness and activity levels, making it difficult to adhere to a regular exercise COPD, being a chronic disease with a prolonged course and recurring symptoms, predisposes patients to negative emotions such as anxiety and These emotions, as part of the psychological stress response, can impair cognitive function, emotional regulation.
ORIGINAL ARTICLE Table 2.
Determinants of respiratory exercise adherence in middle-aged and elderly COPD patients.
Variable Assignment P-value Good = 0.
Poor = 1 Ai Ai Ai Ai Sex Male = 0.
Female = 1 Age >70 years = 0.
O70 years = 1 Education Level High school or above = 0.
Junior high or below = 1 Ou5 years = 0.
<5 years = 1 Drug Dependence No = 0.
Yes = 1 Anxiety Status Absent = 0.
Present = 1 Depression Status Absent = 0.
Present = 1 Social Support Level High = 0.
Low = 1 Ai Dependent Variable Adherence to Respiratory Function Exercise Independent Variables Disease Duration Constant Note: *p<0,05 and self-management capabilities, thereby reducing adherence and motivation for respiratory function exercise.
16 Moreover, anxiety and depression can affect the autonomic nervous and endocrine systems, leading to physiological changes such as tachypnea, tachycardia, and elevated blood pressure.
These reactions can exacerbate respiratory symptoms, ultimately fostering a resistance to engaging in respiratory function exercise.
Social support, as a crucial psychological resource, helps individuals cope with life stressors and disease For middle-aged and elderly COPD patients, social support can provide emotional comfort, informational guidance, and practical assistance, aiding in alleviating the psychological stress induced by the disease.
17 However, when social support levels are low, patients may face greater psychological pressure and feelings of loneliness.
These negative emotions can significantly diminish their enthusiasm and adherence to respiratory function exercise.
To address the identified influencing factors, health education is systematically strengthened through regular sessions conducted at least once weekly.
Multimedia resources, including illustrations, videos, and animations, are utilized alongside simplified text and accessible language to ensure comprehensive understanding among patients with diverse educational The educational curriculum is designed to encompass fundamental COPD knowledge, the clinical significance of respiratory function exercises, specific training methodologies, and necessary safety precautions.
Furthermore, the integration of successful case studies is emphasized within these sessions to provide practical evidence of efficacy and enhance patient motivation, thereby fostering more robust adherence to the prescribed non-pharmacological To optimize therapeutic outcomes and ensure patient safety, personalized exercise plans are implemented through a strategy of gradual progression, initiated with fundamental breathing techniques and followed by incremental increases in both intensity and duration.
Throughout the intervention, the exercise process is strictly supervised by healthcare professionals, by whom the patientAos physical performance systematically recorded.
Consequently, these exercise protocols are dynamically adjusted in response to the patientAos real-time clinical status and functional progress, ensuring that the rehabilitation remains both safe and efficacious for the 18 Medication Management and Psychological Intervention: For patients with drug dependence, establish medication records and guide them on proper medication use.
Provide regular education on medication knowledge.
Employ methods such as cognitive-behavioral therapy and music therapy to help patients identify and modify maladaptive thought patterns, thereby alleviating psychological Simultaneously, establish a psychological counseling hotline to offer patients accessible and timely psychological support.
To strengthen the social support framework, peer support groups are established to facilitate the exchange of personal experiences and mutual Furthermore, diverse resources from family members, community volunteers, and social organizations are mobilized to ensure that comprehensive assistance is rendered.
Through this multifaceted approach, emotional comfort, financial aid, and practical support are provided, thereby mitigating the psychological burden and enhancing the overall resilience of patients in managing the challenges of the disease.
In this study, we acknowledge that completing questionnaires in a hospital setting may exert potential effects on patientsAo self-reported compliance and Patients may exhibit social desirability bias Bali Medical Journal 2026.
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ORIGINAL ARTICLE
under medical supervision, leading to overestimated adherence and biased psychological scores.
Hospital-related anxiety and unfamiliarity may further distort self-evaluations of emotional status, which could reduce the external validity of the findings.
In contrast, home and community environments reflect daily life more realistically and provide higher ecological validity.
To minimize such bias, we adopted anonymous completion, non-attendance of medical staff, confidential data Nevertheless, the hospital setting remains an inherent limitation of this study.
Future studies are recommended to adopt longitudinal designs with repeated assessments across hospital, home, and community settings to capture more authentic behavioral and psychological changes.
Accordingly, caution should be taken when interpreting and generalizing the present results, especially for communitybased interventions and practical clinical CONCLUSION In summary, risk factors such as being aged O70 years, having an educational level of junior high school or lower, a disease duration of less than 5 years, drug dependence, and anxiety can negatively influence adherence to respiratory exercise among middle-aged and elderly COPD patients.
Based on these insights, clinical practices should consider targeted strategies like intensified health education, phone follow-ups, medication management, psychological support, and strengthened social support systems.
Nevertheless, the studyAos limitationsAi including a relatively small sample sizeAi may affect the resultsAo reliability.
Future research should aim to enlarge the sample and explore these adherence factors more comprehensively to yield stronger evidence for clinical application.
CONFLICT OF INTEREST
AUTHOR CONTRIBUTIONS.
Jixing Huang: Research design and methodology development, data collection and organization, manuscript writing and Chao Liu: Statistical analysis of data, manuscript review and editing, critical intellectual review, and guidance of the articleAos content.
Yao Chen: Data collection and organization, manuscript review and editing, critical intellectual review, and guidance of the articleAos content.
MEDICAL ETHICS
This study was approved by the Medical Ethics Committee.
Approval No.
Written informed consent was obtained from all participants included in this study.
FUNDING INFORMATION
This research received no external funding or financial support.
GENERATIVE AI DISCLOSURE
The authors declare that no generative AI or AI-assisted writing tools were utilized during the preparation of this manuscript.
REFERENCES