Mechanisms of simplified sitting Badunjin effects on symptom burden: a network-based cross-lagged analysis in...

This study used contemporaneous networks and cross-lagged panel network (CLPN) to examine how the Simplified Sitting Badunjin (SSBDJ) intervention interacted with the fatigue, sleep disturbances, and quality of life (QoL) at different follow-up stages in advanced cancer patients.

This was a secondary analysis of a randomized controlled trial. Data were collected at baseline (T0), 4 weeks (T1), 8 weeks (T2), 12 weeks (T3) of the intervention, and 4 weeks (T4) after the intervention. A total of 3 constructs with 16 dimensions (fatigue severity, fatigue interference, sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, physical discomfort, food related concerns, healthcare concerns, support, negative emotions, existential distress, sense of alienation, value of life) were included in the symptom network, which consists of contemporaneous and cross-lagged panel networks.

A total of 175 participants were included in the network analysis. Within the contemporaneous network, "Fatigue interference" emerged as the central symptom in both the intervention and control groups (intervention group: EI value = 1.249 (T1), 2.610 (T2); control group: EI value = 1.462 (T1), 1.950 (T2)). In the longitudinal network analysis, SSBDJ was strongly negatively associated with fatigue severity and interference at T0 → T1 (β = -0.497, -0.504) and T1 → T2 (β = -0.210, -0.256). Additionally, fatigue consistently served as a central node within the networks, demonstrating the highest out-expected influence across 12-week intervention period. The impact of fatigue (out-EI: r = 2.641) on sleep disturbances and quality of life tended to exert independent influence in the mid stage of intervention (T2 → T3). Furthermore, fatigue (out-predictability: r = 1.993) remained a dominant predictor of sleep disturbances and quality of life even after the intervention (T3 → T4).

This study enhances the understanding of the longitudinal relationships between the SSBDJ intervention, fatigue, sleep disturbances, and QoL among patients with advanced cancer. It could provide an important insight for designing precise symptom management strategies in mind-body exercise interventions among this population.