The Relationship Between Physical Exercise And Cognitive Frailty Among The Elderly In The Community And The Mediating Moderating Effect

ObjectivesThrough a cross-sectional survey of the elderly in the community,this study aims to explore the status quo and the influencing factors of cognitive frailty,physical exercise,self-efficacy and coping style of the elderly;to explore the mediating and moderating effects of self-efficacy and coping style between physical exercise and cognitive frailty of the elderly.In-depth understanding of the mechanism between physical exercise and cognitive frailty can provide effective methods for preventing and delaying the occurrence of cognitive frailty in the elderly,and at the same time contribute to the realization of healthy aging.MethodsFrom December 2020 to July2021,the elderly in Kaifeng city,Henan Province who met the inclusion and exclusion criteria of this study and lived in the community for≥1 year were conveniently selected as the research objects.The tools included the General information questionnaire,Frailty Phenotype（FP）,The Montreal Cognitive Assessment（Mo CA）,The Physical Activity Rating Scale-3（PARS-3）,General Self-efficacy Scale（GSES）,and Simplified Coping Style Questionnaire（SCSQ）.A total of 470questionnaires were distributed and 470 were recovered.After excluding invalid questionnaires,456remained,and the effective recovery rate was 97.02%.Epidata 3.1 was used to establish the database,and SPSS 21.0 software and R software were used for data statistical analysis.Statistical methods include:descriptive analysis,t test,ANOVA,test,linear regression and logistic regression.The mediating effect of self-efficacy between physical exercise and cognitive frailty was tested by distribution of product of the coefficients method with RMediation software package,and the moderating effect of coping style between physical exercise and cognitive frailty was verified by multiple logistic regression.Results1.Descriptive analysis:In this study,89 elderly people in the community suffered from cognitive frailty,accounting for 19.5%;the score of physical exercise of the elderly in community was（22.68±7.31）;the self-efficacy score of the elderly in community was（21.45±3.17）;the average score of positive coping items was（1.80±0.18）,and negative coping items was（1.66±0.18）.2.Univariate analysis:There were significant differences in age,gender,marital status,average monthly personal incomes,sleep status and chronic diseases in physical exercise among the elderly（p<0.05）;there were significant differences in age,gender,educational,average monthly incomes,sleep status,chronic disease and SCD status of the elderly in self-efficacy（p<0.05）;there were significant differences in age,marital status,educational,smoking history,average monthly incomes,sleep status,chronic diseases and SCD of the elderly in positive coping style（p<0.05）;and were significant differences in negative coping style in age,gender,educational,smoking history,residence form,monthly average incomes and SCD（p<0.05）;and cognitive frailty of the elderly in the community showed that age,marital status,educational,smoking history,drinking history,average monthly personal incomes,sleep status,chronic disease,SCD,physical exercise（physical exercise intensity,duration,frequency）,self-efficacy,positive coping style and negative coping style were the influencing factors,and the difference was statistically significant（p<0.05）.3.Logistic regression analysis:Age,chronic disease,SCD,physical exercise（physical exercise intensity,duration,frequency）,self-efficacy and positive coping style were the main factors affecting the cognitive frailty of the elderly in community（p<0.05）.4.Mediating effect analysis:The 95%confidence interval（CI）of the mediation effect obtained by the distribution of product of the coefficients method by the RMediation software package of R software was[-0.053,-0.024],excluding 0,that is,the mediating effect of self-efficacy between physical exercise and cognitive frailty is significant.After standardizing the coefficients of each path,a _STD=0.268,b _STD=-0.459,c’_STD=-0.275,and c _STD=-0.412 were obtained,so the mediating effect ratio of self-efficacy was30.91%.5.Moderating effect analysis:Positive coping style strengthens the protective effect of physical exercise on cognitive frailty（β=0.035;OR=1.036;p<0.001）,on the contrary,negative coping style reduced the positive effect of physical exercise on cognitive frailty（β=-0.062;OR=0.940;p<0.001）.ConclusionsThe incidence of cognitive frailty of the elderly in the community is relatively high,which can be influenced by many factors;physical exercise can not only directly affect the cognitive frailty of the elderly in the community,but also indirectly through self-efficacy;positive coping style positively moderated the relationship between physical exercise and cognitive frailty,while negative coping style negatively moderated the relationship between them.Therefor,community medical workers should pay special attention to improving the enthusiasm for physical exercise of the elderly in the community,improve the level of self-efficacy of the elderly,and encourage them to take positive coping styles,so as to delay the occurrence and development of their cognitive frailty.