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Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study

Year 2025, Volume: 9 Issue: 1, 195 - 204, 31.01.2025
https://doi.org/10.30621/jbachs.1568984

Abstract

Purpose: This study aimed to examine the relationship of kinesiophobia (fear of movement) and physical activity level with dyspnea, peripheral muscle strength and proprioceptive acuity in patients with chronic obstructive pulmonary disease (COPD).
Metarial and Methods: A total of 36 COPD patients (mean age: 66.94 ± 10.40 years) were included in this retrospective cross-sectional study. Within the scope of the purpose of the current study, the patients’ demographics, respiratory symptoms, as well as clinical characteristics such as kinesiophobia level, physical activity level, dyspnea severity, peripheral muscle strength, and proprioceptive level were recorded from the patient file.
Results: The majority of the patients (72.2%) were GOLD Stage 2. The patients had a high level of kinesiophobia (≥ 37 points), low physical activity level, prolonged sitting time, and high dyspnea severity (mMRC ≥ 2). In addition, the quadriceps, iliopsoas and tibialis anterior muscle strength of the patients were 7.47±2.40 kg, 7.34±2.06 kg and 8.93 (7.10/9.60) kg, respectively, and the patients’ knee proprioception (degree of deviation from the target angle) were 3.50 (1.33/4.16) degrees. Kinesiophobia level showed a significant relationship with physical activity level and sitting time (p<0.05). Additionally, the patients' kinesiophobia level showed a moderate significant relationship with dyspnea severity, quadriceps and tibialis anterior muscle strength (p<0.05). In addition, the physical activity level showed a moderate to strong significant correlation with sitting time, dyspnea severity, proprioceptive level, and muscle strength (p<0.05).
Conclusion: Dyspnea, peripheral muscle strength, and proprioceptive levels are important interrelated parameters that increase kinesiophobia and limit physical activity in COPD. Therefore, dyspnea, peripheral muscle strength, and proprioception should be evaluated within the scope of pulmonary rehabilitation from the early period, and therapeutic approaches aiming to minimize the effects of these symptoms should be included in the pulmonary rehabilitation program.

References

  • Fabbri LM, Hurd SS. Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update. Eur Respir J 2003;22(1):1-2.
  • O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Adv Ther 2020;37(1):41-60.
  • Hanania NA, O'Donnell DE. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Int J Chron Obstruct Pulmon Dis 2019;14:1127-38.
  • Wüst RC, Degens H. Factors contributing to muscle wasting and dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2007;2(3):289-300.
  • Cielen N, Maes K, Gayan-Ramirez G. Musculoskeletal disorders in chronic obstructive pulmonary disease. Biomed Res Int 2014;2014:965764.
  • Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J 2012;40(5):1115-22.
  • Eymir M, Yakut H, Özalevli S, Alpaydın A. Static and dynamic balance impairment and relationship with disease-related factors in patients with chronic obstructive pulmonary disease: A cross-sectional study. Wien Klin Wochenschr 2021;133(21-22):1186-94.
  • SH K. Kinesiophobia: a new view of chronic pain behavior. J Pain Manage 1990;3:35-43.
  • Liang F, Liu M, Han H, Ru Y, Yin Y, Cheng C, et al. Identifying patterns of kinesiophobia trajectories among COPD patients: A longitudinal study. Nurs Open 2023;10(6):3925-35.
  • Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One 2013;8(3):e57949.
  • Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, Kulich K. Improving physical activity in COPD: towards a new paradigm. Respir Res 2013;14(1):115.
  • Wang J, Bai C, Zhang Z, Chen O. The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: Cross-sectional survey and mediated moderation analysis. Heart Lung 2023;59:95-101.
  • Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Inal-Ince D, Arikan H, Coplu L. The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2019;41(18):2159-63.
  • Saka S, Gurses HN, Bayram M. Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial. Complement Ther Clin Pract 2021;44:101418.
  • Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017;195(5):557-82.
  • Yilmaz O, Yakut Y, Uygur F, Ulug N. Turkish version of the Tampa Scale for Kinesiophobia and its test-retest reliability. Turk J Physiother Rehabil 2011;22(1):44-9.
  • Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62(3):363-72.
  • Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills 2010;111(1):278-84.
  • Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54(7):581-6.
  • O'Shea SD, Taylor NF, Paratz JD. Measuring muscle strength for people with chronic obstructive pulmonary disease: retest reliability of hand-held dynamometry. Arch Phys Med Rehabil 2007;88(1):32-6.
  • Riemann BL, Myers JB, Lephart SM. Sensorimotor system measurement techniques. J Athl Train 2002;37(1):85-98.
  • Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 2018;126(5):1763-8.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175-91.
  • Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189(9):e15-62.
  • Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2018;198(2):175-86.
  • Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158(2):629-34.
  • Seymour JM, Ward K, Raffique A, Steier JS, Sidhu PS, Polkey MI, et al. Quadriceps and ankle dorsiflexor strength in chronic obstructive pulmonary disease. Muscle Nerve 2012;46(4):548-54.
  • Van't Hul A, Harlaar J, Gosselink R, Hollander P, Postmus P, Kwakkel G. Quadriceps muscle endurance in patients with chronic obstructive pulmonary disease. Muscle Nerve 2004;29(2):267-74.
  • Souza de Vasconcelos G, Eduarda Chinotti Batista da Silva M, G SN, Viadanna Serrão F. Relationship between kinesiophobia, isometric hip and knee torques to pelvic, hip and knee motion during the single-leg drop jump in women with patellofemoral pain: A cross-sectional study. Knee 2023;42:264-72.
  • Eymir M, Unver B, Karatosun V. Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022;30(8):2776-85.
  • Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39(8):1435-45.
  • Özel A, Yümin ET, Tuğ T, Konuk S. Evaluation of physical activity, kinesiophobia, daily life activities and quality of life in individuals with chronic obstructive pulmonary disease in different phenotypes. Arch Physiother Rehabil 2019;2(1):7-17.
  • Gürses HN, Saka S, Uçgun H, Zeren M, Bayram M. Obstacle of physical activity and activities of daily living in patients with COPD: dyspnea related kinesiophobia. Eur Respiratory J 2019;54(Suppl 63):PA1247.
  • Park JK, Deutz NEP, Cruthirds CL, Kirschner SK, Park H, Madigan ML, et al. Risk Factors for Postural and Functional Balance Impairment in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2020;9(2):609.
  • Oliveira CC, Lee A, Granger CL, Miller KJ, Irving LB, Denehy L. Postural control and fear of falling assessment in people with chronic obstructive pulmonary disease: a systematic review of instruments, international classification of functioning, disability and health linkage, and measurement properties. Arch Phys Med Rehabil 2013;94(9):1784-99.e7.
  • Sarıtaş Arslan M, Akıncı B, Kuran Aslan G, Erelel M, Yıldız S. The proprioception in copd: What are the clinical determinants? Chest 2019;155(6):A377.
  • Chuatrakoon B, Ngai SPC, Sungkarat S, Uthaikhup S. Balance Impairment and Effectiveness of Exercise Intervention in Chronic Obstructive Pulmonary Disease-A Systematic Review. Arch Phys Med Rehabil 2020;101(9):1590-602.
  • Munari AB, Gulart AA, Araújo J, Zanotto J, Sagrillo LM, Karloh M, et al. Modified Medical Research Council and COPD Assessment Test Cutoff Points. Respir Care 2021;66(12):1876-84.
  • Barreiro E, Gea J. Respiratory and Limb Muscle Dysfunction in COPD. Copd 2015;12(4):413-26.
  • Stoeckel MC, Esser RW, Gamer M, Büchel C, von Leupoldt A. Brain Responses during the Anticipation of Dyspnea. Neural Plast 2016;2016:6434987.
  • Banzett RB, Moosavi SH. Dyspnea and pain: similarities and contrasts between two very unpleasant sensations. APS Bulletin 2001;11(1):1-6.

Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study

Year 2025, Volume: 9 Issue: 1, 195 - 204, 31.01.2025
https://doi.org/10.30621/jbachs.1568984

Abstract

References

  • Fabbri LM, Hurd SS. Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update. Eur Respir J 2003;22(1):1-2.
  • O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Adv Ther 2020;37(1):41-60.
  • Hanania NA, O'Donnell DE. Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. Int J Chron Obstruct Pulmon Dis 2019;14:1127-38.
  • Wüst RC, Degens H. Factors contributing to muscle wasting and dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2007;2(3):289-300.
  • Cielen N, Maes K, Gayan-Ramirez G. Musculoskeletal disorders in chronic obstructive pulmonary disease. Biomed Res Int 2014;2014:965764.
  • Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J 2012;40(5):1115-22.
  • Eymir M, Yakut H, Özalevli S, Alpaydın A. Static and dynamic balance impairment and relationship with disease-related factors in patients with chronic obstructive pulmonary disease: A cross-sectional study. Wien Klin Wochenschr 2021;133(21-22):1186-94.
  • SH K. Kinesiophobia: a new view of chronic pain behavior. J Pain Manage 1990;3:35-43.
  • Liang F, Liu M, Han H, Ru Y, Yin Y, Cheng C, et al. Identifying patterns of kinesiophobia trajectories among COPD patients: A longitudinal study. Nurs Open 2023;10(6):3925-35.
  • Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One 2013;8(3):e57949.
  • Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, Kulich K. Improving physical activity in COPD: towards a new paradigm. Respir Res 2013;14(1):115.
  • Wang J, Bai C, Zhang Z, Chen O. The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: Cross-sectional survey and mediated moderation analysis. Heart Lung 2023;59:95-101.
  • Vardar-Yagli N, Calik-Kutukcu E, Saglam M, Inal-Ince D, Arikan H, Coplu L. The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease. Disabil Rehabil 2019;41(18):2159-63.
  • Saka S, Gurses HN, Bayram M. Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial. Complement Ther Clin Pract 2021;44:101418.
  • Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017;195(5):557-82.
  • Yilmaz O, Yakut Y, Uygur F, Ulug N. Turkish version of the Tampa Scale for Kinesiophobia and its test-retest reliability. Turk J Physiother Rehabil 2011;22(1):44-9.
  • Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62(3):363-72.
  • Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills 2010;111(1):278-84.
  • Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54(7):581-6.
  • O'Shea SD, Taylor NF, Paratz JD. Measuring muscle strength for people with chronic obstructive pulmonary disease: retest reliability of hand-held dynamometry. Arch Phys Med Rehabil 2007;88(1):32-6.
  • Riemann BL, Myers JB, Lephart SM. Sensorimotor system measurement techniques. J Athl Train 2002;37(1):85-98.
  • Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 2018;126(5):1763-8.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175-91.
  • Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189(9):e15-62.
  • Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2018;198(2):175-86.
  • Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158(2):629-34.
  • Seymour JM, Ward K, Raffique A, Steier JS, Sidhu PS, Polkey MI, et al. Quadriceps and ankle dorsiflexor strength in chronic obstructive pulmonary disease. Muscle Nerve 2012;46(4):548-54.
  • Van't Hul A, Harlaar J, Gosselink R, Hollander P, Postmus P, Kwakkel G. Quadriceps muscle endurance in patients with chronic obstructive pulmonary disease. Muscle Nerve 2004;29(2):267-74.
  • Souza de Vasconcelos G, Eduarda Chinotti Batista da Silva M, G SN, Viadanna Serrão F. Relationship between kinesiophobia, isometric hip and knee torques to pelvic, hip and knee motion during the single-leg drop jump in women with patellofemoral pain: A cross-sectional study. Knee 2023;42:264-72.
  • Eymir M, Unver B, Karatosun V. Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022;30(8):2776-85.
  • Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39(8):1435-45.
  • Özel A, Yümin ET, Tuğ T, Konuk S. Evaluation of physical activity, kinesiophobia, daily life activities and quality of life in individuals with chronic obstructive pulmonary disease in different phenotypes. Arch Physiother Rehabil 2019;2(1):7-17.
  • Gürses HN, Saka S, Uçgun H, Zeren M, Bayram M. Obstacle of physical activity and activities of daily living in patients with COPD: dyspnea related kinesiophobia. Eur Respiratory J 2019;54(Suppl 63):PA1247.
  • Park JK, Deutz NEP, Cruthirds CL, Kirschner SK, Park H, Madigan ML, et al. Risk Factors for Postural and Functional Balance Impairment in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2020;9(2):609.
  • Oliveira CC, Lee A, Granger CL, Miller KJ, Irving LB, Denehy L. Postural control and fear of falling assessment in people with chronic obstructive pulmonary disease: a systematic review of instruments, international classification of functioning, disability and health linkage, and measurement properties. Arch Phys Med Rehabil 2013;94(9):1784-99.e7.
  • Sarıtaş Arslan M, Akıncı B, Kuran Aslan G, Erelel M, Yıldız S. The proprioception in copd: What are the clinical determinants? Chest 2019;155(6):A377.
  • Chuatrakoon B, Ngai SPC, Sungkarat S, Uthaikhup S. Balance Impairment and Effectiveness of Exercise Intervention in Chronic Obstructive Pulmonary Disease-A Systematic Review. Arch Phys Med Rehabil 2020;101(9):1590-602.
  • Munari AB, Gulart AA, Araújo J, Zanotto J, Sagrillo LM, Karloh M, et al. Modified Medical Research Council and COPD Assessment Test Cutoff Points. Respir Care 2021;66(12):1876-84.
  • Barreiro E, Gea J. Respiratory and Limb Muscle Dysfunction in COPD. Copd 2015;12(4):413-26.
  • Stoeckel MC, Esser RW, Gamer M, Büchel C, von Leupoldt A. Brain Responses during the Anticipation of Dyspnea. Neural Plast 2016;2016:6434987.
  • Banzett RB, Moosavi SH. Dyspnea and pain: similarities and contrasts between two very unpleasant sensations. APS Bulletin 2001;11(1):1-6.
There are 41 citations in total.

Details

Primary Language English
Subjects Chest Diseases
Journal Section Research Article
Authors

Musa Eymir 0000-0002-9671-9583

Hazal Yakut Ozdemir 0000-0003-4918-9249

Sevgi Özalevli 0000-0002-5528-1036

Aylin Özgen Alpaydın 0000-0002-5711-1372

Publication Date January 31, 2025
Submission Date October 17, 2024
Acceptance Date December 20, 2024
Published in Issue Year 2025 Volume: 9 Issue: 1

Cite

APA Eymir, M., Yakut Ozdemir, H., Özalevli, S., Alpaydın, A. Ö. (2025). Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study. Journal of Basic and Clinical Health Sciences, 9(1), 195-204. https://doi.org/10.30621/jbachs.1568984
AMA Eymir M, Yakut Ozdemir H, Özalevli S, Alpaydın AÖ. Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study. JBACHS. January 2025;9(1):195-204. doi:10.30621/jbachs.1568984
Chicago Eymir, Musa, Hazal Yakut Ozdemir, Sevgi Özalevli, and Aylin Özgen Alpaydın. “Investigation of the Relationship of Kinesiophobia and Physical Activity Level With Dyspnea, Muscle Strength, and Proprioception in Patients With Chronic Obstructive Pulmonary Disease: A Retrospective Study”. Journal of Basic and Clinical Health Sciences 9, no. 1 (January 2025): 195-204. https://doi.org/10.30621/jbachs.1568984.
EndNote Eymir M, Yakut Ozdemir H, Özalevli S, Alpaydın AÖ (January 1, 2025) Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study. Journal of Basic and Clinical Health Sciences 9 1 195–204.
IEEE M. Eymir, H. Yakut Ozdemir, S. Özalevli, and A. Ö. Alpaydın, “Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study”, JBACHS, vol. 9, no. 1, pp. 195–204, 2025, doi: 10.30621/jbachs.1568984.
ISNAD Eymir, Musa et al. “Investigation of the Relationship of Kinesiophobia and Physical Activity Level With Dyspnea, Muscle Strength, and Proprioception in Patients With Chronic Obstructive Pulmonary Disease: A Retrospective Study”. Journal of Basic and Clinical Health Sciences 9/1 (January 2025), 195-204. https://doi.org/10.30621/jbachs.1568984.
JAMA Eymir M, Yakut Ozdemir H, Özalevli S, Alpaydın AÖ. Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study. JBACHS. 2025;9:195–204.
MLA Eymir, Musa et al. “Investigation of the Relationship of Kinesiophobia and Physical Activity Level With Dyspnea, Muscle Strength, and Proprioception in Patients With Chronic Obstructive Pulmonary Disease: A Retrospective Study”. Journal of Basic and Clinical Health Sciences, vol. 9, no. 1, 2025, pp. 195-04, doi:10.30621/jbachs.1568984.
Vancouver Eymir M, Yakut Ozdemir H, Özalevli S, Alpaydın AÖ. Investigation of the Relationship of Kinesiophobia and Physical Activity Level with Dyspnea, Muscle Strength, and Proprioception in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Study. JBACHS. 2025;9(1):195-204.