臺灣博碩士論文加值系統

骨質疏鬆症（osteoporosis）是影響婦女骨骼系統健康最常見的疾病之一，也是目前造成老年人骨折的重要原因，因此對骨質疏鬆症進行深入的瞭解並發展預防及治療的方式，已是目前不可忽視的課題。由於骨骼系統與肌肉系統有一定的相關性，因此運動被認為可能是一種有效的預防及治療方式，而採用運動做為治療方法的優點包括：較無副作用，可強化肌肉韌帶系統對骨骼的支持，並增加包括心心肺耐力等整體的功能表現，對預防相關的慢性疾病亦有助益，這是其它治療無法取代的優點。因此本研究的目的包括：1.探討停經後婦女骨質較低者（postmenopausal osteopenia）與其日常活動量（physical activity）是否有關。2.探討停經後婦女骨質較低者與其健康體適能（health-related fitness）是否有關。3.研究中等強度（moderate intensity）以上之承重有氧運動訓練（weight-bearing aerobic exercise training）對停經後婦女骨質較低患者骨密度（bone mineral density, BMD）的治療效果。本論文之研究分為兩部份，第一部份比較正常骨密度及骨質較低之停經後婦女其日常活動量和健康體適能是否有差異，實驗設計為案例控制（case-control study）的研究方式。受試者共有74位，年齡為42-65歲。經過雙能量X光射線吸收儀（dual energy X-ray absorptiometry, DEXA）檢查骨密度，腰椎（L2-4）和右股骨頸的骨密度均低於年輕女性平均值1個標準差以上者有43位（L2-4為0.7600.089 g/cm2, 股骨頸為0.6560.052 g/cm2），列為骨質較低組；其他31位受試者的L2-4和右股骨頸的骨密度均在正常範圍者為健康組（L2-4骨密度為1.0550.092 g/cm2, 股骨頸為0.8450.088 g/cm2）。測試項目包括：骨密度檢查、七日活動量問卷及體適能檢查。體適能檢查包括：慣用手最大握力和雙膝伸肌肌力、雙膝伸肌耐力，柔軟度、體組成分析及最大運動測試。另以問卷調查受試者的鈣質攝取量，並記錄荷爾蒙的使用情形。結果顯示骨質較低之停經後婦女其日常活動量、體脂肪、非脂肪組織及最大攝氧量，在經過停經年數、鈣質攝取量及體質指數（body mass index）的校正後，仍明顯較健康組低（p<0.05）。兩組的柔軟度、肌力和肌耐力等肌肉系統的功能經校正後並無統計上明顯差異（p>0.05）。第二部份探討給予停經後婦女骨質較低者中等強度以上之承重有氧運動訓練對骨密度的治療效果，為介入式（intervention study）實驗設計。受試者是將第一部份的43位骨質較低病患分為兩組，其中22位自願參與每週3次每次50分鐘，為期24週的運動訓練，列為運動組；另外21位為控制組，不給任何運動指示，同時要求受試者在這段期間不要改變生活及飲食習慣。運動訓練內容以承重式的有氧運動為主，包括跑步機及階梯運動，每次約50分鐘。所有測試項目在訓練結束後重測，比較兩組骨密度的變化，以探討運動訓練的效果。經過24週的運動訓練之後，實驗組有17位（77.3%）受試者完成運動訓練及所有檢查，控制組有20位完成。訓練之前兩組的基本資料和所有檢查包括日常活動量及體適能檢查均無明顯的差異，除了運動組右膝伸肌耐力明顯較控制組差（p<0.05）。訓練之後，兩組受試者L2-4和股骨頸骨密度在訓練前後的變化（difference）有統計上明顯的差異（p<0.05），但左右股骨髁骨密度的變化未達統計上明顯的差異（p>0.05）。此外兩組健康體適能在訓練前後的變化包括柔軟度、肌力、肌耐力、體脂肪及最大攝氧量都有統計上明顯的差異（p<0.05）。總結本研究的結果顯示正常骨密度與骨密度較低之停經後婦女的日常活動量及健康體適能的確有顯著的差異，而增加運動量可延緩骨密度流失的情形。未來的研究應繼續定量活動量、營養和藥物等治療方式對骨密度的影響，並建立治療性的運動計劃來改善骨質疏鬆症高危險群的運動處方。

摘要……………………………………………………………….1
第一章 前言…………………………………………………….4
第一節 研究背景……………………………………………….4
第二節 研究目的……………………………………………….7
第三節 實驗假說……………………………………………….7
第四節 研究的顯著性………………………………………….8
第五節 研究限制…………………………………………………9
第六節 使用名詞定義………………………………………….10
第二章、文獻回顧……………………………………………….11
第一節 正常骨骼的再塑過程………………………………….11
第二節 停經後之骨骼再塑異常……………………………….12
第三節 骨密度之測量方法…………………………………….13
放射線學檢查………………………………………………….13
骨生化代謝檢查……………………………………………….16
第四節 活動量評估量表……………………………………….18
第五節 運動或活動量與骨質疏鬆症的相關性……………….22
第六節 運動對骨密度的影響………………………………….24
第七節 運動訓練改善骨密度的可能機轉………………………28
第三章、方法與程序…………………………………………… 29
研究設計……………………………………………………….29
第一部份………………………………………………………….29
受試者………………………………………………………….29
儀器及特別程序……………………………………………….30
第二部份………………………………………………………….36
受試者………………………………………………………….36
儀器及特別程序……………………………………………….36
運動訓練……………………………………………………….36
統計方法………………………………………………………….37
第四章、結果…………………………………………………….. 38
第一部份：日常活動量及健康體適能之比較………………….38
受試者的基本資料…………………………………………….38
日常活動量及健康體適能之比較…………………………….38
第二部份：運動對骨質較低患者的訓練效果………………….39
運動訓練前後骨密度的變化………………………………..39
運動訓練前後體適能的變化………………………………..40
日常活動量和鈣質攝取評估………………………………..41
第五章、討論…………………………………………………….43
第一節 干擾因子………………………………………………. 43
第二節 體組成與骨密度……………………………………….44
第三節 日常活動量與骨密度………………………………….45
第四節 最大攝氧量與骨密度………………………………….46
第五節 肌肉系統功能與骨密度……………………………….46
第六節 運動訓練的參數……………………………………….48
第七節 與過去相關研究的比較……………………………….49
第八節 運動對健康體適能的效果…………………………….52
第六章、總結…………………………………………………….54
第一節 目的…………………………………………………….54
第二節 程序…………………………………………………….54
第三節 結果整理……………………………………………….55
第四節 結論…………………………………………………….55
第五節 未來研究方向………………………………………….55
第六節 總結…………………………………………………….56
附件1.同意書……………………………………………………69
附件2.日常活動評估量表………………………………………70
附件3.鈣質攝取問卷……………………………………………72
附件4.記錄表……………………………………………………73
參考文獻………………………………………………………….74
表格
表1.日常活動評估量表……………………………………………58
表2.運動與骨質疏鬆症的相關性研究……………………………59
表3.運動訓練對骨質疏鬆症的影響………………………………60
表4.受試者之基本資料……………………………………………61
表5.日常活動量評估………………………………………………62
表6.健康體適能檢查………………………………………………63
表7.運動組與控制組訓練前後基本資料及骨密度………………64
表8.運動組與控制組訓練前後基本資料及骨密度的變化………65
表9.運動組與控制組訓練前後之健康體適能……………………66
表10.運動組與控制組訓練前後健康體適能的變化……………..67
表11.運動組及控制組在研究期間內能量消耗和鈣質攝取的追蹤調查68

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