臺灣博碩士論文加值系統

目的：本研究目的旨在了解 40 至 64 歲之正常血壓的中年人，從事單次中等費力強度 (70% heart rate reserved) 有氧運動後，對 24 小時動態血壓之影響，並探討背景變項與 24 小時動態血壓值的關係。方法：招募 24 名自願參與的中年人，以隨機方式進行 2 種實驗介入處理，分別為單次固定式腳踏車之中等費力強度有氧運動及實驗室中之未運動處理（模擬控制）。統計方法：(1) 以相依樣本 t 檢定，考驗不同介入處理（有氧、模擬）在平均 24 小時、日間和夜間血壓數值（收縮壓、舒張壓和平均壓）及心跳率的差異。(2) 採用重複量數二因子變異數分析 (two-way ANOVA, repeated measures)，考驗不同介入處理中每小時血壓數值及心跳率之時間曲線的差異，若達顯著水準再以最小差異法 (least significance difference, LSD) 進行事後比較。(3) 使用克—瓦二式單因子變異數等級分析 (Kruskal-Wallis one-way analysis of variance ranks) 瞭解身體活動情形與 24 小時動態血壓的差異。(4) 使用獨立樣本 t 考驗 (independent-sample t-test) 瞭解不同性別、抽菸情形及飲酒情形之24小時動態血壓的差異。(5) 使用皮爾遜積差相關 (Pearson’s product-moment correlation) 檢視年齡、身體質量指數、體脂肪百分比、去脂體重、骨骼肌質量與 24 小時動態血壓的關係。結果：(1) 兩種實驗介入處理，在平均 24 小時、晨間和夜間之收縮壓、舒張壓及平均壓並無顯著差異存在 (p > .05)，僅中等費力強度有氧運動之晨間心跳率 (t21 = -2.821, p = .01) 有顯著較模擬控制高的情形。(2) 兩種實驗介入處理，在時間曲線上之心跳率 (F(21,441) = 6.016, p < .05) 呈現顯著交互作用情形，經單純主要效果分析後發現，中等費力強度有氧運動後之心跳率顯著高於未運動處理，並至少維持 6 個小時；然而，收縮壓、舒張壓及平均壓等血壓數值中並無顯著交互作用存在。(3) 不同身體活動量之24小時動態血壓並無顯著差異情形。(4) 男性之平均 24 小時SBP (t20 = 3.294, p = .004)、DBP (t20 = 3.156, p = .005) 及MAP (t20 = 2.876, p = .009) 顯著高於女性；抽菸者之平均 24 小時 DBP (t20 = 2.628, p = .016) 及 MAP (t20 = 2.292, p = .033) 顯著高於沒有抽菸者；然而不同飲酒情形之動態血壓並無顯著差異。(5) 身體質量指數與平均 24 小時收縮壓 (r = .53, p < .05) 及平均壓 (r = .44, p < .05) 達顯著正相關；然而，年齡、體重、身高、體脂肪百分比、脂肪重、除脂體重等變項與 24 小時動態血壓之間並無顯著相關。結論：正常血壓中年人從事單次中等費力有氧運動後並不會造成動態血壓顯著降低的情形，但運動後心跳率會顯著提高至少6個小時。抽菸及身體質量指數與 24 小時動態血壓間有顯著關連性，因此，避免抽菸並維持正常的身體質量指數應為正常血壓中年人保健血壓的首要考量。

The purposes of this study were (a) to understand the effect of normotension middle-aged adults, aged 40 to 64 yrs, after taking acute moderate-to-vigorous intensity aerobic exercise, and an ambulatory blood pressure (ABP) monitoring, (b) to discuss the relationships between participant’s characteristics (age, smoking, drinking, body mass index, percentage of body-fat, free-fat mass, skeletal muscle mass, and physical activity) and ABP. Methods: Twenty-four volunteers were recruited, and all of them were interfered randomly with two types of exercise (acute cycling ergometer aerobic exercise and virtual without exercise). (1) Paired t-tests were used to test the differences between two intervenes on blood pressure (BP), including systolic BP, diastolic BP and mean BP in mean 24-hours BP, day-time BP, night-time BP and heart rate. (2) Repeated-measures two-way ANOVAs were used to analyze temporal curves differences of two intervenes (BP, and heart rate), if significant using post hoc by least significance difference. (3) Independent-sample t-test were used to test the differences of smoking, gender, drinking in ABP. (4) Pearson’s product-moment correlation coefficients were used to examine the relationships between participant’s characteristics and ABP. Result: (1) There is no significance between two type of exercises in BP which including systolic BP, diastolic BP and mean BP in mean 24-hours BP, day-time BP, night-time BP. Day-time heart rate (t21 = -2.821, p = .01) of moderate-to-vigorous intensity aerobic exercise was significantly higher than virtutal. (2) The interaction effect of heart rate of temporal curves of two intervenes were significant (F(21,441) = 6.016, p < .05), and simple main effect showed moderate-to-vigorous intensity aerobic exercise was higher than virtutal for at least six hours; however, there were no significant interaction in systolic BP, diastolic BP and mean BP. (3) Smokers showed higher 24-hour diastolic BP (t20 = 2.628, p = .016) and mean BP (t20 = 2.292, p = .033). (4) BMI was positively correlated with 24-hour systolic BP (r = .53, p < .05) and mean BP (r = .44, p < .05); however, there were no correlations between 24-hour BP and other participant’s characteristics. Conclusions: Normotension middle-aged adults have no significant reduction of ABP after moderate-to-vigorous intensity aerobic exercise, but their heart rate were significant increased for at least for six hours. Because 24-h ABP were significantly related with among somking habits and BMI, Therefore, the top priority for blood pressure health in normotension middle-aged adults is to avoid smoking and to keep normal BMI.

謝誌..............................................................................................................................Ⅰ
中文摘要......................................................................................................................Ⅲ
英文摘要......................................................................................................................Ⅴ
目錄..............................................................................................................................Ⅶ
表次..............................................................................................................................Ⅹ
圖次..............................................................................................................................XI
第壹章 　緒論..............................................................................................................1
第一節 前言........................................................................................................1
第二節 研究背景................................................................................................1
第三節 研究目的................................................................................................5
第四節 研究問題................................................................................................5
第五節 研究假設................................................................................................6
第六節 名詞操作性定義....................................................................................6
第七節 研究範圍與限制....................................................................................8
第八節 研究重要性............................................................................................8
第貳章 　文獻探討......................................................................................................9
第一節 診間血壓與 24 小時動態血壓測量之臨床意義...............................9
一、 血壓要素及測量方法.........................................................................9
二、 診間血壓之臨床意義........................................................................11
三、 24 小時動態血壓之臨床意義..........................................................16
第二節 單次有氧運動對24小時動態血壓的影響........................................21
第三節 運動後低血壓的機制..........................................................................28
第四節 本章小結..............................................................................................34
第參章 　研究方法與步驟........................................................................................36
第一節 研究流程..............................................................................................36
第二節 研究對象..............................................................................................37
第三節 研究時間與地點..................................................................................37
第四節 研究工具..............................................................................................38
第五節 實驗程序及方法..................................................................................39
第六節 資料處理與統計分析..........................................................................44
第肆章 研究結果...................................................................................................45
第一節 參與者基本資料.................................................................................45
第二節 單次不同實驗介入處理對平均24小時、晨間及夜間動態血壓之比較.........................................................................................................47
第三節 單次中等費力強度有氧運動對24小時動態血壓各小時的影響.........................................................................................................49
第四節 不同身體活動量、性別、抽菸情形及飲酒情形之24小時動態血壓的差異.................................................................................................51
第五節 參與者背景變項與24小時動態血壓之關係...................................53
第伍章 討論...........................................................................................................55
第一節 單次不同實驗介入處理對平均24小時、晨間及夜間動態血壓之比較.........................................................................................................55
第二節 單次中等費力強度有氧運動對24小時動態血壓各小時的影.........................................................................................................58
第三節 不同身體活動量、性別、抽菸情形及飲酒情形之24小時動血壓的差異.....................................................................................................60
第四節 參與者背景變項與24小時動態血壓之關係...................................63
第陸章 結論與建議...............................................................................................64
第一節 結論.....................................................................................................64
第二節 建議.....................................................................................................65
引用文獻.....................................................................................................................66
　　中文部分.............................................................................................................66
　　英文部分.............................................................................................................67
附錄.............................................................................................................................77
　　附錄一　參與實驗說明.....................................................................................77
　　附錄二　參與者基本資料及健康狀況調查表..................................................78
　　附錄三　參與者同意書......................................................................................80
　　附錄四　行政院衛生署授權及IPAQ身體活動量短版問卷……………......81
　　附錄五　單次中等費力有氧運動之人體測量學及血流動力學測量紀錄表..........................................................................................................88
　　附錄六　相依樣本 t 考驗摘要表.....................................................................91
　　附錄七　運動後時間點與國際標準時間之對照表..........................................92
　　附錄八　重複量數二因子變異數分析摘要表..................................................93
　　附錄九　2種實驗處理與22個時間點所構成之邊緣平均數摘要表............99
　　附錄十　不同身體活動量與動態血壓之克—瓦二氏單因子變異數等級分析摘要表................................................................................................102

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