老年慢性疼痛患者24h活动行为与疼痛的等时替代效应研究
Associations Between 24-Hour Movement Behaviors and Pain in Older Adults With Chronic Pain: an Isotemporal Substitution Analysis
周驰程 1王林 1刘诗洁 1王支纪 1詹丽 1史峰瑞 2王宏2
作者信息
- 1. 武汉理工大学体育学院;湖北民族传统体育文化传承与创新研究中心
- 2. 武汉体育学院武术学院
- 折叠
摘要
背景 慢性疼痛是一种常见的伴随情绪障碍、功能障碍，且超出组织损伤预期愈合时间的综合性慢病，其影响范围广，对广大老年人心理、生活、社会功能等方面产生持久影响。目的 探讨患有慢性疼痛的老年人24 h活动行为分布特征及时间重新分配与疼痛预测值之间的关联。方法 于2024年9—11月在湖北省武汉市武汉理工大学东、西社区，采取随机抽样的方法招募60岁以上的老年慢性疼痛患者84例为研究对象。24 h活动行为［久坐行为、睡眠、低强度身体活动（LPA）、中高强度身体活动（MVPA）］时间分布采用加速度计客观测量和24 h活动行为日志主观测量互证的方法获取。采用成分数据多元线性回归分析探究24 h活动行为与老年人慢性疼痛的关联。采用汉化版整体疼痛量表（GPS）测量老年人整体疼痛情况，运用等时替代模型探究老年慢性疼痛患者24 h活动行为分别与疼痛总分及4个子维度（疼痛、情绪感受、临床表现、日常行为）的关系，并探究24 h活动行为变化与疼痛总分及各子维度的剂量 - 效应关系。结果 成分数据多元线性回归分析结果显示，老年慢性疼痛患者24 h活动行为模型与疼痛总分及各维度均显著相关（P<0.001），其中MVPA时间占比与疼痛总分呈负相关（β=-0.612，P<0.001），而久坐行为、睡眠时间占比与疼痛总分呈正相关（β=0.450，P0.05）。等时替代模型分析结果显示，MVPA替代久坐行为、睡眠、LPA时疼痛总分及各维度预测值均降低（P<0.05），替代久坐行为、睡眠、LPA时疼痛总分预测值分别降低 0.538、0.564、0.592，反之被久坐行为、睡眠、LPA 替代时疼痛总分预测值分别增加 1.087、1.111、1.131；且在等时替代模型整体中MVPA替代LPA时疼痛总分的预测值降幅最大（β=-0.592，95%CI=-0.891~-0.294）。MVPA与睡眠、久坐行为及LPA之间的相互替代与疼痛总分的剂量 - 效应关系具有明显的不对称性，其他行为替代 MVPA 疼痛预测值上升的幅度大于 MVPA 替代其他行为疼痛预测值下降的幅度；当MVPA与其他行为相互替代时，每天替代至少5 min预测值变化最为明显。结论 老年慢性疼痛患者的日常活动呈现久坐少动的特征，较高的久坐、睡眠时长与疼痛得分较高相关；MVPA替代其他行为与老年慢性疼痛患者疼痛预测值降低相关；剂量 - 效应关系表明MVPA具有较高的关联价值，MVPA与其他行为相互替代至少5 min预测值变化最为明显。
Abstract
Background Chronic pain is a common and complex chronic condition accompanied by emotional disorders and functional impairment, and it persists beyond the expected healing time of tissue injury. It has a wide impact and produces lasting effects on psychological health, daily life, and social functioning among older adults. Objective To explore the distribution characteristics of 24-hour movement behaviors among older adults with chronic pain and the associations between time reallocation and predicted pain values. Methods From September to November 2024, 84 patients with chronic pain aged over 60 years were recruited by random sampling from the East and West Communities of Wuhan University of Technology in Wuhan, Hubei Province, China. Time distribution of 24-hour movement behaviors, including sedentary behavior, sleep, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) was assessed using a combination of objective accelerometer measurements and subjective 24-hour movement behavior logs. Overall pain was assessed using the Chinese version of the Global Pain Scale (GPS), which comprises four subdimensions: pain, emotional feelings, clinical manifestations, and daily behaviors. Compositional data multivariable linear regression was used to examine the association between 24-hour movement behaviors and chronic pain in older adults. Isotemporal substitution models were used to examine the associations between time reallocation among 24-hour movement behaviors and the total pain score (TS) as well as the four subdimension scores. Dose response relationships between changes in 24-hour movement behaviors and predicted TS and subdimension scores were also examined. Results Compositional data multivariable linear regression showed that the 24-hour movement behavior model was significantly associated with TS and all four subdimension scores in older patients with chronic pain (P<0.001). A greater proportion of time spent in MVPA was negatively associated with TS (=-0.612, P<0.001), whereas greater proportions of time spent in sedentary behavior and sleep were positively associated with TS (=0.450, P0.05). Reallocating time from sedentary behavior, sleep, or LPA to MVPA was associated with lower predicted TS and subscale scores (P<0.05). The corresponding predicted decreases in TS were 0.538, 0.564, and 0.592, respectively. Conversely, reallocating the same amount of time from MVPA to sedentary behavior, sleep, or LPA was associated with predicted increases in TS of 1.087, 1.111, and 1.131, respectively. The largest predicted decrease in TS occurred when time was reallocated from LPA to MVPA (=-0.592, 95%CI=-0.891 to -0.294). Doseresponse relationships were asymmetric: reallocating time from MVPA to other behaviors was associated with larger predicted increases in TS than the decreases associated with the reverse reallocations. Changes in predicted scores were most pronounced when at least 5 min/d was reallocated between MVPA and other behaviors. Conclusion Older adults with chronic pain exhibit a daily movement pattern characterized by prolonged sedentary time and low physical activity levels. Greater relative time spent in sedentary behavior and sleep was associated with higher pain scores. Reallocating time from other behaviors to MVPA is associated with lower predicted pain scores. Dose-response relationships highlight the association between MVPA time reallocation and predicted pain scores, with the most pronounced changes observed when at least 5 min/d is reallocated between MVPA and other behaviors.关键词
慢性疼痛/老年人/24 h 活动行为/等时替代效应/久坐行为/睡眠Key words
Chronic pain/Aged/24-hour movement behaviors/Isotemporal substitution/Sedentary behavior/Sleep引用本文复制引用
周驰程,王林,刘诗洁,王支纪,詹丽,史峰瑞,王宏.老年慢性疼痛患者24h活动行为与疼痛的等时替代效应研究[EB/OL].(2026-10-26)[2026-10-30].https://chinaxiv.org/abs/202610.00206.学科分类
临床医学
