臺灣博碩士論文加值系統

中文摘要

老年人跌倒對身體功能多有明顯的損傷，嚴重影響生活品質。缺乏肌力與失去平衡是老年人發生跌倒的主要原因，適當的運動可以有效的幫助老年人減緩肌力流失和改善平衡能力，進而降低發生跌倒的風險。在台灣地區，從事元極舞運動的老年人口眾多。本研究除了分析元極舞動作內容，主要目的在於進一步探討1.元極舞運動對老年人下肢肌力及平衡能力之影響；2.不同元極舞舞齡在平衡能力及下肢肌力之差異。
本研究以台灣宜蘭地區65-74歲從事元極舞運動(n=25；平均年齡68.5+2.8歲)，無規律運動習慣(n=18；平均年齡69.7+3.7歲)的老年人為實驗參與者。元極舞運動者均學會元極舞共10集動作，包括6位舞齡3-5年、9位舞齡5-8年以及10位舞齡8年以上的老年女性。主要測驗項目包括：下肢肌力(30秒坐站)、靜態平衡(Catsys2000測力板開眼單足站立)及動態平衡(Catsys2000測力板+Reebok動態訓練板雙足站立)。將測驗所得資料以獨立樣本t考驗及單因子變異數分析進行統計分析處理。
研究結果顯示，元極舞運動組在下肢肌力及平衡能力皆顯著優於無規律運動組。非慣用腳單足站立的各項平衡擺動參數皆達顯差異(p<.05)，這與元極舞下肢動作時間的特性有關。兩組動態、靜態平衡能力的差異在平衡擺動面積皆達顯差異(p<.05)，這與元極舞下肢動作空間的特性有關。在不同元極舞舞齡方面，除了下肢肌力項目8年以上組明顯優於3-5年組及5-8年組，其他項目則無顯著差異。三組不同舞齡的實驗參與者都是長期並且規律地參與運動。因此研究推論，長期從事元極舞運動有助於老年人平衡能力與下肢肌力的維持。

關鍵詞：元極舞、平衡能力、下肢肌力

英文摘要

This study, with a qualitative component analysis of the movements of Yuan-Ji Dance, aims to investigate the effect of Yuan-Ji Dance, along with the span of participation, on balance and lower-extremity strength in the old people. The subjects of this study include 25 old Yuan-Ji Dance participants, with an average age of 68.5+2.8, and 18 sedentary controls, aged 69.7+3.7 years. All the Yuan-Ji participants have learned the ten sets of Yuan-Ji acts and are divided into three span groups: 3-5 years (n=6), 5-8 years (n=9) and over 8 years (n=10). Physical performance is assessed using (1) static balance: one-leg stance with eye open for 30 seconds on Catsys 2000 force platform on flat ground, (2) dynamic balance: both-feet stance with eye open for 30 seconds on Catsys 2000 force platform placed on Reebok Dynamic platform and (3) lower-extremity strength: 30-second chair stand test. The data for comparison between the Yuan-Ji group and the sedentary controls are analyzed with t-test, with a=.05, while the data for comparison among three Yuan-Ji dance spans are analyzed with one-way ANOVA, with p<.05.
The results of this study show that the Yuan-Ji group performs significantly better than the sedentary group both in balance control ability and in lower-extremity strength. Specifically, in the non-dominant-leg stance test, the Yuan-Ji group has all the balance functions significantly better than the sedentary group, which is proposed to have a close connection with the time frame of lower-limb movements in Yuan-Ji Dance. Besides, in static as well as dynamic balance, the significance is mainly found in the function of sway area, which is suggested to be in connection with the spatial features of the Yuan-Ji movements. Among the three Yuan-Ji dance span groups, the group of the longest span has lower-extremity strength significantly better than the other two groups, but in balance control ability, the three groups show no significant difference. It is concluded that participating in Yuan-Ji Dance regularly and continuously (over 3 years) helps the old people to maintain their performance of balance and lower-extremity strength.
Key words: Yuan-Ji Dance, balance, lower-extremity strength

論 文 目 次
中文摘要 I
英文摘要 II
謝 誌 III
論 文 目 次 IV
表次 VII
圖次 VIII
第一章 緒 論 1
第一節 前言 1
第二節 問題背景 2
第三節 研究目的 5
第四節 研究範圍與限制 5
第五節 名詞操作性定義 6
第六節 研究的重要性 7
第二章 文獻探討 8
第一節、老年人跌倒的相關研究 8
第二節、老年人平衡能力與運動的相關研究 12
第三節、老年人下肢肌力與運動的相關研究 16
第四節、台灣地區元極舞運動 19
第五節、結語 20
第三章 研究方法與步驟 22
第一節 研究對象 22
第二節 研究設計 23
第三節 測驗時間與地點 23
第四節 測驗方法與步驟 25
第五節 資料處理與分析 33
第四章 結果 34
第一節、元極舞運動組與無規律運動組之下肢肌力 34
第二節、不同元極舞舞齡之下肢肌力 35
第三節、元極舞運動組與無規律運動組之平衡能力 36
第四節、不同元極舞舞齡之平衡能力 39
第五章 討論與結論 43
第一節、元極舞運動組與無規律運動組在下肢肌力方面之比較 43
第二節、不同元極舞舞齡在下肢肌力方面之比較 44
第三節、元極舞運動組與無規律運動組在平衡能力方面之比較 44
第四節、不同元極舞舞齡在平衡能力方面之比較 47
第五節、結論與建議 48
參考文獻 50
附錄一：元 極 舞 動 作 分 析 百 分 比 率 表 60
附錄二：台灣宜蘭地區「高齡者平衡能力及下肢肌力檢測」計劃說明 61
附錄三：實驗參與者須知 62
附錄四：實驗參與者同意書 63
附錄五：台灣宜蘭地區「高齡者平衡能力及下肢肌力」實驗參與者個人資料表 64

表次
表 4-1-1：受試者基本資料 34
表4-1-2：元極舞運動組與無規律運動組30秒坐站測驗資料表 34
表4-2-1：不同元極舞舞齡30秒坐站測驗資料表 35
表4-2-2：不同元極舞舞齡30秒坐站測驗成績變異數分析摘要表 35
表4-3-1：元極舞運動組與無規律運動組靜態開眼單足站立資料表 36
表4-3-2：元極舞運動組與無規律運動組動態雙足站立資料表 38
表4-4-1：不同元極舞舞齡靜態開眼單足站立資料表 39
表4-4-2：不同元極舞舞齡靜態開眼單足站立成績變異數分析摘要表 40
表4-4-3：不同元極舞舞齡動態雙足站立資料表 41
表4-4-4：不同元極舞舞齡動態雙足站立成績變異數分析摘要表 42

圖次
圖 3-3-1：測驗場地布置 24
圖 3-4-1：30秒坐站測驗 26
圖 3-4-2：開眼單足站立測驗 28
圖 3-4-3：雙足站立於動態環境反應測試 30
圖 3-4-4：慣用腳測試 31
圖 3-4-5：實驗流程示意圖 32

參考文獻

簡世煜、林曼蕙。(2004)。老年人參與元極舞運動在平衡能力及下肢肌力之效應。發表於2004兒童健康與適應身體活動國際學術研討會，204。
李世國。(2004)。有無規律慢跑運動中老年人平衡能力與下肢肌力之
比較研究。未出版碩士論文，國立台灣師範大學，台北市。
鄭名涵。(2003)。不同運動型態中老年人平衡能力、反應時間與下肢肌力之比較。未出版碩士論文，國立台灣師範大學，台北市。
張燕明。(2002)。老年人不同休閒運動型態之平衡控制效果。未出版碩士論文，國立台灣體育學院，台中市。
中華民國九十一年台灣地區衛生統計。(2002)。行政院衛生署。
胡名霞。(2001)。動作控制與動作學習。台北：金名圖書。
林佩欣、曾旭民、鄭寶釵、黃美娟、鄧復旦。(1999)。太極拳老年人感覺運
動功能的影響。中華民國物理治療學會雜誌，24（4），234-240。
黃漢年、陳全壽（1999）。不穩定平衡維持時間之研究。中華民國大
專院校八十八年度體育學術研討會專刊，303-308。
傅麗蘭、楊政峰。(1998)。看護中心老人的健康狀況及身體功能。中華物療誌，23(3) ，194-199。
張志祥。(1997)。中國元極功法，卷一。北京：科學出版社。
林正常。(1997)。運動生理學。台北：師大書苑。
胡名霞、林慧芬。(1994)。成年人站立平衡之研究---感覺整合與年齡效應
之分析。中華物療誌，19(1)，66-77。
樓迎、陳君侃、黃榮棋、王錫五。(1994)。實用生理學。台北:匯華。
胡名霞、林慧芬。(1994)。成年人站立平衡之研究---感覺整合與年齡效應之分析。中華物療治，19(1)，66-77。
陳坤檸。(1993)。年齡與骨骼肌特性──肌力的變化。中華體育，7(3)，132-138。，
黃子庭、廖秀珠。(1993)。台北市北投區社區居家老人跌倒的情形及其相關因素之探討。公共衛生，20(3): 234-246.
Berg, K. O., Maki, B. E., Williams, J. I., Holliday P. J., & Wood-Dauphinee S. L. (1992). Clinical and laboratory measures of postural balance in an elderly population. Archives of Physical Medicine & Rehabilitation. 73(11), 1073-80.
Blake, A. J., Morgan, K., Bendall, M. J., dallosso, H., Ebrahim, S. B. J., Arie, T. H. D., Fentem, P. H., and Bassey, E. J. (1988). Falls by elderly people at home:prevalence and associated factors, Age Ageing, 17, 365-367.
Bohannon, R. W. (1995). Sit-to-stand test for measuring performance of lower extremity muscles. Perceptual and Motor Skills, 80, 163-166.
Brooks, G. A., & Fahey, T. D. (1984). Exercise physiology—Human bio-energetic and its application. New York: Johnwiley & Sons.
Brown, M., Sinacore, D. R., & Host, H. H. (1995). The relationship of strength to function in the older adult. Journal of Gerontology, 50A (Special Issue), 55-59.
Buchner, D. M., Cress, M.E. de., Lateur, B. J., Esselman, P. C., Margherita, A. J., Price, R., & Wagner, E. H. (1997). The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Journals of Gerontology. Series A, Biological Sciences & Medical Sciences. 52(4), M218-24.
Buchner, D. M., and Wagner, E. H. (1992). Preventing frail health, Clin. Geriatr. Med., 8(1), 1-17.
Burleigh, A. L., & Horak, F. B. (1996). Influence of instruction, prediction, and afferent sensory information on the postural organization of step initiation. Journal Neural; 75(4): 1619-1628.
Burton, A. W., & Miller, D. E. (1998). Movement Skill Assessment. Braun Brumfiled: Human Kinetics.
Chang, H. A. & Krebs, D. E. (1999). Dynamic balance control in elders: Gait initiation assessment as a screening tool. Arch Phys Med Rehabil 1999; 80: 490-494.
Cochrane Database of Systematic Reviews. (2001). CD000340, Gillespie, L. D., Gillespie, W. J., Robertson, M. C., Lamb, S. E., Cumming, R. G., & Rowe, B. H.
Daubney, M.E., & Culham, E.G. (1999). Lower-extremity muscle force and balance performance in adults aged 65 years and older. Physical Therapy. 79(12), 1177-85.
Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. British Medical Journal. 20, 325,128-31.
Department of Health and Human Services, Physical activity and health: A report of the Surgeon General, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, 1996.
Department of Health and Human Services. (1999). Healthy People 2010, Draft for Public Comment. (www.healthypeople2010.com).
Elble, R. J., Moody, C., Leffler, K. & Sinha, R. (1994). The initiation of normal walking. Mov Disord; 9(2): 139-146.
Frank, J. S. & Earl, M. (1990). Coordination of posture and movement. Phys Ther 1990; 70(12): 855-863.
Galloway, M. T., & Jokl, P. (2000). Aging successfully: the importance of physical activity in maintaining health and function. Journal of the American Academy of Orthopedic Surgeons. 8(1), 37-44.
Gauchard, G. C., Jeandel, C., Tessier, A., & Perrin, P. P. (1999). Beneficial effect of proprioceptive physical activities on balance control in elderly human subjects. Neuroscience Letters. 273(2), 81-4.
Gauchard, G. C., Jeandel, C., & Perrin, P. P. (2001). Physical and sporting activities improve vestibular afferent usage and balance in elderly human subjects. Gerontology. 47(5), 263-70.
Gillespie, L. D., Gillespie, W. J., Robertson, M. C., Lamb, S. E., Cumming, R. G., & Rowe, B. H. (2001). Cochrane Database of Systematic Reviews. CD000340.
Guskiewicz, K. M. (1999). Chapter 7: Regaining Balance and Postural Equilibrium. In: W. E. Prentice(Ed.). Rehabilitation Techniques in Sports Medicine. New York: McGraw-Hill.
Hettinger, R. (1960). Physiology of Strength. Springfield: Charles C.　Thomas.
Hong, Y., Li, J. X., & Robinson, P. D. (2000). Balance control, flexibility, and cardio respiratory fitness among older Tai Chi practitioners. British Journal of Sports Medicine, 34(1), 29-34.
Horak, F. B. (1991). Assumptions underlying motor control for neurologic rehabilitation. In: Lister M.J. (ed). Contemporary management of motor control problems. Alexandria, VA: Foundation for Physical Therapy.
Horak, F. B. & Macpherson, J. (1996). Postural orientation and equilibrium. In: Rowell LB, Shepherd JT. Handbook of Physiology: A Critical, Comprehensive Presentation of Physiological Knowledge and Concepts. New York: American Physiological Society, 1996: 255-292.
Hu, M. H., & Woollacott, M. H. (1994). Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance. Journal of Gerontology. 49(2), M52-61.
Izquierdo, M., Aguado, X., Gonzalez, R., Lopez, J. L., & Hakkinen, K. (1999). Maximal and explosive force production capacity and balance performance in men of different ages. Eur J Appl Physiol Occup Physiol. 79(3), 260-7.
Jette, A. M., & Branch, L. G. (1981). The Framingham disability study: II—Physical disability among the aging. Am. J. Public Health, 71:1211-1216.
Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise & Sport. 70(2), 113-9.
Layne, C., & Abraham, L. D. (1987). Patterns of lower limb muscle activity in young boys during a one foot static balance Task. Research Quarterly for Exercise and Sport. 58(1)：36-44.
Ledin, T., Kronhed, A. C., Moller, C., Moller, M., Odkvist, L. M. & Olsson, B. (1990). Effects of balance training in elderly evaluated by clinical tests and dynamic posturography. Journal of Vestibular Research, 1, 129-138.
Lee, D. N., & Lishman, R. (1975). Visual proprioceptive control of stance. Journal of Human Movement Studies. 1,87-95
Lehmann, J. F., de Lateur, B. J. (2000). Falls and Balance. In Fiatarone, M. A.(Eds). Exercise, Nutrition, and the Older Women—Wellness for Women Over Fifty (pp.269-278). CRC Press LLC.
Leoers, R., Bigard, A. X., Diard, J. P., Gouteyron, J. F., & Guezennec, C. Y. (1997). Posture control after prolonged exercise. European Journal of Applied Physiology and Occupational Physiology. 76(1), 55-61.
Lord, S. R., Lloyd, D. G., Nirui, M., Raymond, J., Williams, P., & Stewart, R. A. (1996). The effect of exercise on gait patterns in older women: a randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences & Medical Sciences. 51(2), M64-70.
Mann, R. A., Hagy, J. L., White, V. & Liddell, D. (1979). The initiation of gait. J. Journal of Bone and Joint Surgical, 61: 232-239.
Matheson, A. J., Darlington, C. L., & Smith, P. F. (1999). Further evidence for age-related deficits in human postural function. Journal of Vestibular Research. 9(4):261-4.
Mazzeo, R. S., Cavanagh, P., Evans, W. J., Fiatarone, M., Hagberg, J., McAuley, E. and Startzell, J. (1998). ACSM Position Stand on Exercise and Physical Activity for Older Adults. Med. Sci. Sports. Exerc., Vol. 30, No. 6:992-1008.
Mobily, K. E., Lane B. K., & Semerjian, T. Z., (1998). Using progressive resistance training as an intervention with older adult. Therapeutic Recreation Journal, 32(1), 42-53.
Murray, M. P., Wood, A. A., & Susan, B. S. (1975). Normal postural stability and steadiness quantitative assessment. Journal of Bone and Joint Surgical, 57, 510-515.
Nashner, L. M. (1993). Practical Biomechanics and Physiology of Balance. In G. Jacobsen, C. Newman, & J. Kartush (Eds). Handbook of balance function and testing (pp.261-279). St. Louis MO: Mosby Year Book.
Nickens, H. (1985). Intrinsic factors in falling among the elderly. Archives of Internal Medicine, 145, 1089-1093.
Nyberg L & Gustafson Y. (1995). Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies. Stroke 1995; 26: 838-842.
Okumiya, K., Matsubayashi, K., Nakamura, T., Fujisawa, M., Osaki, Y., Doi, Y. & Ozawa, T. (1998). The Timed "Up & Go" test is a useful predictor of falls in community-dwelling older people [letter; comment]. J Am Geriatr Soc; 46(7): 928-30.
Overstall, P. W., Exton-Smith, A. N., Imms, F. J., and Johnson, A. L. (1997). Falls in the elderly related to postural in balance, Brit. Med. J., 1, 261-264.
Perrin, P. P., Gauchard, G. C., Perrot, C., & Jeandel, C. (1999). Effects of physical and sporting activities on balance control in elderly people. British Journal of Sports Medicine. 33(2), 121-6.
Peterka, R. J., & Black, F. O. (1990). Age-related changes in human posture control: sensory organization tests. Journal of Vestibular Research. 1(1), 73-85.
Podsiadlo, D., Richardson, S. (1991). The Timed "Up and Go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc; 39: 142-148.
Richter, E. (1980). Quantitative study of human Scarpa's ganglion and vestibular sensory epithelia. Acta Oto-Laryngologica. 90(3-4), 199-208.
Rikli, R. E., & Jones, C. J. (2001). Senior Fitness Test Manual. Champaign, IL: Human Kinetics.
Schaller, K. J. (1996). Tai Chi Chih: An exercise option for older adults. Journal of Gerontological Nursing, 22(10), 12-17.
Sheldon, J. H. (1963). The effect of age on the control of sway. Gerontologia Clinica. 5, 129-138.
Shephard, R. J. (1997). Aging , physical activity, and health. Human Kinetics.
Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Time Up& Go Test. Phys Ther 2000, 80 (9):896-903.
Spirduso, W. W. (1995). Physical dimensions of aging. Champaign IL: Human Kinetics.
Tse, S. K., & Bailey, D. M.(1992). Tai Chi and postural control in the well elderly. The American Journal of Occupational Therapy, 46, 295-300.
Tinetti, M. E., Doucette, J. T., & Claus, E. B. (1995). The contribution of predisposing and situational risk factors to serious fall injuries. Journal of the American Geriatrics Society. 43(11):1207-13.
Tinetti, M. E., Doucette, J., Claus, E., & Marottoli, R. (1995). Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatrics Society. 43(11), 1214-2.
Tinetti, M. E., Speechley, M., & Ginter, S. F. (1989). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 80, 429-434.
Tinetti, M. E., Williams, T. F., & Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic conditions. American Journal of Medicine, 80, 429-434.
Topper, A. K., Maki, B. E. & Holliday, P. J. (1993). Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall. J Am Geriatr Soc; 41: 479-487.
Van Heuvelen, M. J., Kempen, G. I., Ormel, J., & Rispens, P. (1998). Physical fitness related to age and physical activity in older persons. Medicine & Science in Sports & Exercise. 30(3):434-41.
Vandervoort, A. A. (1992). Effects of aging on human neuromuscular function: implications for exercise. Canadian Journal of Sports & Sciences, 17(3):178-184.
Wagner, E. H., LaCroix, A. Z., Grothaus, L., Leveille, S. G., Hecht, J. A., Artz, K., Odle, K., and Buchner, D. M. (1994). Preventing disability and falls in older adults: a population-based randomized trial, Am. J. Public Health, 84(11), 1800-1806.
Winter, D. A. (1995). A.B.C. (Anatomy, Biomechanics and Control) of Balance during Standing and Walking. 1st. Canada: Winter DA..
Wong, A. M., Lin, Y. C., Chou, S. W., Tang, F. T., & Wong, P. Y. (2001). Coordination exercise and postural stability in elderly people: Effect of Tai Chi Chuan. Archives of Physical Medicine & Rehabilitation. 82(5):608-12.
Woolley, S. M., Czaja, S. J., & Drury, C. G. (1997). An assessment of falls in elderly men and women. Journals of Gerontology. Series A, Biological Sciences & Medical Sciences. 52(2), M80-7.
Woollacott, M. H., Shumway-Cook, A., & Nashner, L. M. (1986). Aging and posture control: changes in sensory organization and muscular coordination. International Journal of Aging & Human Development, 23(2), 97-114.
Woollacott, M. H. & Tang, P. F. (1997). Balance control during walking in the older adults: Research and its implications. Phys Ther; 77: 646-660.