Potential Effect of Walking on Emotional Health among Breast Cancer Survivors: the Mediating Effects of Different Dimensions of Posttraumatic Growth

doi:10.12114/j.issn.1007-9572.2022.0797

Abstract

Abstract:

Background

Breast cancer has become the most prevalent cancer worldwide, which leads to both physical symptom burden and psychological distress among patients. Although available literature has demonstrated the effect of physical activity in improving psychological health among breast cancer survivors, the underlying psychosocial mechanism is relatively understudied.

Objective

To investigate the association of walking with positive and negative affect among breast cancer patients, and examine the potential mediating effects of different dimensions of posttraumatic growth between them.

Methods

From April to July, 2019, 256 breast cancer patients receiving community-based management were recruited using convenience sampling from Shanghai Pengpuxincun Community Health Center to attend a household survey. Two hundred and thirty-five of them who completed the survey were included as final participants (achieving a response rate of 91.8%) . Levels of walking were measured using International Physical Activity Questionnaire-Long Form (IPAQ-long) , posttraumatic growth was assessed using Posttraumatic Growth Inventory-Short Form (PTGI-SF) , emotional health was assessed using the 20-item Positive and Negative Affect Scale (PANAS) . Structural equation modeling was conducted to test the parallel mediating effects of different dimensions of posttraumatic growth between walking and positive and negative affect.

Results

The result of intermediary effect analysis show that, walking was associated with greater positive affect through facilitating the personal strength dimension of posttraumatic growth among breast cancer patients, with an indirect effect of 0.07〔95%CI (0.02, 0.13) 〕. Moreover, walking was associated with lower level of negative affect through facilitating the appreciation for life dimension of posttraumatic growth, with an effect size of -0.13〔95%CI (-0.21, -0.05) 〕. The result of the intermediary model show that, the level of walking activity promoted positive emotions (β=0.34, P<0.01) by promoting the personal strength dimension of post-traumatic growth (β=0.21, P<0.01) . In addition, walking activity decreased negative mood (β=-0.37, P<0.01) by promoting the life appreciation dimension of post-traumatic growth (β=0.35, P<0.01) .

Conclusion

Posttraumatic growth plays an important role as a mediator between walking and emotional health in breast cancer patients. In view of this, physicians from community health centers, the institutions responsible for long-term health management of cancer patients, should value walking as a potential intervention for improving psychological health of breast cancer patients in the future community health management. In addition, it is recommended to use both physical activity and psychological interventions to improve posttraumatic growth, in order to further enhance the intervention efficacy.

Key words: Breast neoplasms, Physical activity, Emotional health, Post-traumatic growth, Mediating effect

摘要：

背景

乳腺癌已成为全球发病率首位的癌症，不仅给患者带来身体上的痛苦，也造成了沉重的心理压力。尽管现有研究表明身体活动对乳腺癌患者情绪健康有促进作用，但其潜在的心理机制尚待阐明。

目的

探讨步行活动与乳腺癌患者积极情绪和消极情绪的关系，并探索创伤后成长不同维度在其中的潜在中介效应。

方法

2019年4—7月，采用方便抽样法对在上海市彭浦新村街道社区卫生服务中心进行社区管理的乳腺癌患者进行入户问卷调查。共招募256例患者，其中235例完成问卷填答，应答率为91.8%。采用国际身体活动问卷长问卷（IPAQ-long）中文版评估步行活动水平；采用创伤后成长量表-简版（PTGI-SF）评价患者创伤后成长程度；采用20条目正负情绪量表（PANAS）评估患者情绪健康程度。利用结构方程模型检验创伤后成长不同维度在步行活动对积极情绪和消极情绪中的中介作用。

结果

中介效应分析结果显示，步行活动通过促进创伤后成长中的个人力量维度进而促进乳腺癌患者的积极情绪，间接效应值为0.07〔95%CI（0.02，0.13）〕；步行活动通过促进创伤后成长的生命欣赏维度进而降低消极情绪，效应值为-0.13〔95%CI（-0.21，-0.05）〕。中介作用模型结果显示，步行活动通过促进创伤后成长的个人力量维度（β=0.21，P<0.01）进而促进积极情绪（β=0.34，P<0.01）；此外，步行活动通过促进创伤后成长的生命欣赏维度（β=0.35，P<0.01）进而降低消极情绪（β=-0.37，P<0.01）。

结论

创伤后成长在步行活动对乳腺癌患者情绪健康的影响中起中介作用。鉴于社区卫生服务机构承担着癌症患者的长期健康管理工作，在未来的社区健康管理工作中，医师应重点将步行活动作为改善患者心理健康的干预方式之一。同时，建议将运动干预与促进创伤后成长的心理干预相结合，以提升对患者心理健康的干预效果。

关键词: 乳腺肿瘤, 身体活动, 情绪健康, 创伤后成长, 中介作用

FU Shi,CHEN Chen,YU Mengzhu, et al. Potential Effect of Walking on Emotional Health among Breast Cancer Survivors: the Mediating Effects of Different Dimensions of Posttraumatic Growth[J]. Chinese General Practice, 2023, 26(17): 2089-2094. DOI: 10.12114/j.issn.1007-9572.2022.0797.
付十,陈晨,喻梦珠等. 步行活动对乳腺癌患者情绪健康的潜在影响：创伤后成长不同维度的中介作用研究[J]. 中国全科医学, 2023, 26(17): 2089-2094. DOI: 10.12114/j.issn.1007-9572.2022.0797.

Figures/Tables 7

References 21

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变量	构成比	变量	构成比
肿瘤分期情况		受教育程度
0期	66（28.1）	小学及以下	20（8.5）
Ⅰ期	15（6.4）	初中	104（44.2）
Ⅱ期	58（24.7）	高中	89（37.9）
Ⅲ期	12（5.1）	大专及以上	22（9.4）
Ⅳ期	3（1.3）	当前工作状况
未确定	81（34.5）	全职	7（3.0）
婚姻状况		无工作/退休/病假/在家工作	228（97.0）
已婚	216（91.9）
未婚/离婚/丧偶	19（8.1）

变量	构成比	变量	构成比
肿瘤分期情况		受教育程度
0期	66（28.1）	小学及以下	20（8.5）
Ⅰ期	15（6.4）	初中	104（44.2）
Ⅱ期	58（24.7）	高中	89（37.9）
Ⅲ期	12（5.1）	大专及以上	22（9.4）
Ⅳ期	3（1.3）	当前工作状况
未确定	81（34.5）	全职	7（3.0）
婚姻状况		无工作/退休/病假/在家工作	228（97.0）
已婚	216（91.9）
未婚/离婚/丧偶	19（8.1）

项目	人际关系	新可能性	个人力量	精神改变	生命欣赏	积极情绪	消极情绪
步行活动	0.22^b	0.30^b	0.32^b	0.12	0.34^b	0.15^a	-0.17^b
人际关系	—	0.73^b	0.74^b	0.42^b	0.59^b	0.59^b	-0.40^b
新可能性	—	—	0.73^b	0.47^b	0.65^b	0.57^b	-0.36^b
个人力量	—	—	—	0.47^b	0.59^b	0.51^b	-0.28^b
精神改变	—	—	—	—	0.37^b	0.34^b	-0.01
生命欣赏	—	—	—	—	—	0.38^b	-0.43^b
积极情绪	—	—	—	—	—	—	0.09

项目	人际关系	新可能性	个人力量	精神改变	生命欣赏	积极情绪	消极情绪
步行活动	0.22^b	0.30^b	0.32^b	0.12	0.34^b	0.15^a	-0.17^b
人际关系	—	0.73^b	0.74^b	0.42^b	0.59^b	0.59^b	-0.40^b
新可能性	—	—	0.73^b	0.47^b	0.65^b	0.57^b	-0.36^b
个人力量	—	—	—	0.47^b	0.59^b	0.51^b	-0.28^b
精神改变	—	—	—	—	0.37^b	0.34^b	-0.01
生命欣赏	—	—	—	—	—	0.38^b	-0.43^b
积极情绪	—	—	—	—	—	—	0.09

项目	步行活动	人际关系	新可能性	个人力量	精神改变	生命欣赏	积极情绪	消极情绪
年龄	-0.28^b	-0.12	-0.09	-0.08	-0.03	-0.15^a	-0.06	0.06
确诊癌症至今时间	-0.06	-0.09	-0.04	-0.03	0.04	-0.03	-0.01	0.13^a
肿瘤分期	-0.03	0.07	-0.01	0.00	-0.07	0.10	-0.04	-0.06
受教育程度	0.34^b	0.13^a	0.27^b	0.23^b	0.18^b	0.30^b	0.07	-0.08
婚姻状况	0.01	0.05	0.07	0.02	0.05	-0.06	0.15^a	0.08
当前工作状况	0.21^b	0.15^a	0.05	0.08	-0.15^a	0.20^b	0.07	-0.12
已接受手术治疗	0.07	0.15^a	0.14^a	0.15^a	0.00	0.16^a	-0.01	-0.13^a
已接受化疗	0.13^a	0.12	0.12	0.07	0.04	0.12	-0.04	-0.19^b
已接受放疗	0.06	0.04	-0.06	0.02	0.06	0.04	-0.02	0.00