研究背景與目的： 結合有氧訓練、肌力訓練、平衡與柔軟度的運動有益於健康並延緩衰弱。 本研究目的在於探討十二週結合有氧及阻力的循環訓練、座椅式健康操與無介入組對於安養機構中衰弱及衰弱傾向的高齡者，其身體功能、體適能、身體組成之成效。
研究方法及步驟： 本研究以台北市立浩然敬老院之住民為研究對象，為兩個階段研究設計，第一階段以Fried學者之操作型定義進行衰弱篩檢，並招募衰弱及衰弱傾向之老年人參與第二階段類實驗性運動介入計劃。介入前後進行三組之身體功能測試、身體組成測試、心理憂鬱狀態之問卷。研究結果以混合型雙因子變異數分析(mixed-design two-way ANOVA)比較三組個案介入前後之變化。
研究結果： 第一階段共完成212位住民之衰弱篩檢，44人(20.8%)為衰弱，142人(67.0%)為衰弱傾向。其中69位衰弱或衰弱傾向之住民參與第二階段介入計劃，分成23位循環訓練(平均年齡77.0±8.8歲)，23位座椅式健康操(平均年齡81.1±9.8歲)及23位對照組(平均年齡81.9±7.6歲)。12週介入後，循環訓練組之功能性前伸測試(前測：17.6±7.1公分，後測：19.6±6.3公分，p<0.016)、握力(前測：24.3±6.8公斤，後測：26.7±6.0公斤，p<0.001)、下肢肌力(前測：38.2±16.5磅，後測：50.1±15.4磅，p<0.001)、上下肢肌耐力(前測：19.3±7.3次，後測：22.1±7.1次，p<0.001；前測：16.7±6.1次，後測：20.4±5.7次，p<0.001)、六分鐘行走測試(前測：354.7±123.6公尺，後測：408.4±124.1公尺，p<0.001)、五公尺行走測試(前測：5.8±1.73杪，後測：5.0±1.5秒，p=0.008)；座椅式健康操組之身體功能測試指標大多維持前測水準；相反的，控制組在握力(前測：26.2±6.8公斤，後測：25.1±6.6公斤，p=0.016)，上肢肌耐力(前測：16.4±4.1次，後測：15.1±4.9次，p=0.029)以及六分鐘行走測試(前測：333.6±100.5公尺，後測：313.6±100.0公尺，p = 0.022)則顯著降低。依據重複量測雙因子變異數分析結果，其時間與組別因子具顯著交互作用，表示三組之間的前、後測變化趨勢達到統計上顯著差異。身體組成方面，循環訓練組在介入後肢段肌肉量仍能維持前測水準，而座椅式健康操與控制組則顯著流失其肌肉量(P<.05)。
結論與建議： 本研究結果顯示在十二週運動介入後，較高強度之循環運動顯著提升衰弱及衰弱傾向老年人之身體功能、體適能並維持其肌肉量，進而改善其衰弱狀態；強度較低之座椅式健康操趨向維持原本身體功能但肌肉量些微降低；無介入組則在身體功能、體適能與肌肉量皆顯著衰退。不同程度之運動介入對於衰弱及衰弱傾向老年人存在明顯的劑量反應關係。本研究結果顯示即使是居住在安養機構中衰弱及衰弱傾向的老年人，經過醫療專業人員妥善的運動處方規劃及指導監督之下，運動訓練是可行且有效的。 建議未來研究以大樣本數、隨機抽樣方式並長期追蹤，進一步評估運動訓練對抗衰弱相關之身體功能障礙的效果。

Background and Objective: A combination of aerobic exercise, strength training, balance/posture and flexibility training is recommended to optimize health and delay frailty. This study aimed to compare the dose-response effects of 12-wk “circuit exercise” and “chair-based exercise” with “usual care group” on physical performance and body composition for the elders who lived in a residential care facility and were classified as frail or pre-frail based on Fried criteria.
Materials and Methods: This study was a two-staged study design; a mass frailty screening using the Fried frailty criteria was conducted in the Taipei Municipal Haoran Senior Citizens Home prior to the subsequent quasi-experimental exercise intervention trial. Physical performance and body composition were repeatedly measured before and after the intervention. Mixed-design two-way ANOVA with repeated measures was used to examine the between-group differences. A P-value of less than 0.05 was considered statistically significant.
Results: Two-hundred and twelve subjects participated in the first-staged frailty screening battery. In total, 20.8 % of the subjects were classified as frail, 67.0 % were pre-frail. Sixty-nine subjects enrolling in the subsequent exercise intervention trial were allocated into circuit training group (N=23, mean age: 77.0±8.8 years), chair-based exercise group (N=23, mean age: 81.1±9.8 years) and control group (N=23, mean age: 81.9±7.6 years). After 12-wk exercise intervention, the circuit training group demonstrated significant improvements on physical functions including functional reach test (P=.016), grip strength (P&lt;.001), knee extensor strength (P&lt;.001); upper limb (P&lt;.001) and lower limb muscle endurance (P&lt;.001), 6-minute walking distance (P&lt;.001), as well as 5-m walking time (P=.008). The lighter chair-based exercise group mostly kept their baseline physical performance level. In contrast, the control group revealed significant decline on grip strength (P= .016), upper limb muscles endurance (P=.029) and 6-min walking distance (P=.022). There were significant between-group differences in changes from pre-test to post-test based on the group×time interaction effects (P&lt;.05). Regarding body compositions, the circuit training group mostly kept their limb muscle mass while both chair-based and usual care group demonstrated significant loss of muscle mass (P&lt;.05).
Conclusions and Recommendations: After 12-wk exercise intervention, the more intensive circuit training group showed significant improvements on most measures of physical performance and physical fitness along with keeping their baseline muscle volume. The lighter chair-based exercise group tended to maintain their baseline physical performance level but decreased muscle mass somewhat. The usual care group declined significantly on physical performance, fitness and muscle mass simultaneously. There was obviously a dose–response effect of exercise training for the frail or pre-frail elderly. Our study demonstrated that a well prescribed and supervised exercise training program was feasible and effective even for those frail or pre-frail elderly of advanced age living in the residential care facility. Future investigations with larger sample size, randomized controlled study design, and long-term follow-up to better evaluate the exercise training effects in combating frailty-associated physical impairments are warranted.

TABLE OF CONTENTS i
LIST OF TABLES iv
LIST OF FIGURES v
致謝 vi
中文摘要 viii
Abstract x
CHAPTER ONE: INTRODUCTION 1
1.1. Background 1
1.2. Purpose 3
1.3. Research Hypothesis 4
1.4. Significance of Study 4
CHAPTER TWO: LITERAYURE REVIEW 5
2.1. Frailty: the New Geriatric Syndrome 5
2.1.1. Pathophysiology of frailty 7
2.1.2. Sarcopenia: age related loss of muscle mass 8
2.2. Assessment Tools of Frailty 9
2.2.1. The Fried Criteria 10
2.2.2. The Frailty Index (FI) 12
2.2.3. Other Frailty-Related Assessment Tools 13
2.3. Epidemiology of Frailty in Different Population 14
2.3.1. The application of frailty screening in Chinese population 16
2.4. Intervention of Frailty Syndrome 17
2.5. Physical Activity for Frailty Syndrome 19
2.6 Circuit training: combined aerobic and resistance exercise 20
CHAPTER THREE: MATERIALS AND METHODS 22
3.1. Research Design 22
3.2. Study Subjects 23
3.3. The Modified Fried Criteria 25
3.4. Study Procedure and Protocol for the Exercise Intervention Trial 27
3.4.1. Protocol of circuit training 28
3.4.2. Instrumentation 29
3.4.3. Protocol of chair-based exercise 29
3.5. Assessment of Basic Characteristics and Outcome Measurements 29
3.5.1. Baseline Questionnaire 30
3.5.2 Body composition assessment 32
3.5.3. Physical functional assessment 33
3.6. Data Management and Statistical Analysis 36
CHAPTER FOUR: RESULTS 37
4.1. Classification of the Frailty Phenotype 37
4.2. Baseline Characteristics among Three Groups 38
4.3. Attendance and Compliance of Exercise Interventions 39
4.4. Effectiveness of Physical Function after 12-week Exercise lnterventions 40
4.5. Effectiveness of Body Composition after 12-week Exercise lnterventions 41
4.6. Effectiveness of Physical Activity after 12-week Exercise lnterventions 42
4.7. Effectiveness of Psychological Status after 12-week Exercise Interventions 42
4.8. Change in the Classification of the Frailty Phenotype 43
CHAPTER FIVE: DISSCUSSION 44
5.1. Prevalence of Frailty 44
5.2. Effectiveness of Exercise Interventions in Frail Elderly 46
5.3. Effectiveness of combined aerobic and resistance circuit training in Elderly 48
5.4. Study Limitations 51
CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS 52
REFERENCES 53
APPENDICES 87
Appendix 1. Modified Fried Frailty Criteria 87
Appendix 2. Institutional Review Board (IRB) Certificate of Approval 88
Appendix 3. Informed Consent Form 89
Appendix 4. Assessment Form 93

1. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Jr., Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. J Am Geriatr Soc. 2004;52:625-634
2. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255-263
3. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156
4. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM. Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62:744-751
5. Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC. Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc. 2008;56:68-75
6. Lee IM, Sesso HD, Oguma Y, Paffenbarger RS, Jr. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 2003;107:1110-1116
7. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: A meta-analysis. Stroke. 2003;34:2475-2481
8. Hu G, Barengo NC, Tuomilehto J, Lakka TA, Nissinen A, Jousilahti P. Relationship of physical activity and body mass index to the risk of hypertension: A prospective study in finland. Hypertension. 2004;43:25-30
9. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403
10. Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW. Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care. 2003;26:557-562
11. Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med. 2004;34:371-418
12. Mao Y, Pan S, Wen SW, Johnson KC. Physical activity and the risk of lung cancer in canada. Am J Epidemiol. 2003;158:564-575
13. McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, Woods N, Ockene J. Recreational physical activity and the risk of breast cancer in postmenopausal women: The women's health initiative cohort study. JAMA. 2003;290:1331-1336
14. Donnelly JE, Hill JO, Jacobsen DJ, Potteiger J, Sullivan DK, Johnson SL, Heelan K, Hise M, Fennessey PV, Sonko B, Sharp T, Jakicic JM, Blair SN, Tran ZV, Mayo M, Gibson C, Washburn RA. Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: The midwest exercise trial. Arch Intern Med. 2003;163:1343-1350
15. Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: A randomized trial. JAMA. 2003;290:1323-1330
16. Coupland C, Wood D, Cooper C. Physical inactivity is an independent risk factor for hip fracture in the elderly. J Epidemiol Community Health. 1993;47:441-443
17. Physical activity guidelines for americans. Okla Nurse. 2008;53:25
18. Vanitallie TB. Frailty in the elderly: Contributions of sarcopenia and visceral protein depletion. Metabolism. 2003;52:22-26
19. Taaffe DR. Sarcopenia--exercise as a treatment strategy. Aust Fam Physician. 2006;35:130-134
20. Bauer JM, Sieber CC. Sarcopenia and frailty: A clinician's controversial point of view. Exp Gerontol. 2008;43:674-678
21. Binder EF, Yarasheski KE, Steger-May K, Sinacore DR, Brown M, Schechtman KB, Holloszy JO. Effects of progressive resistance training on body composition in frail older adults: Results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:1425-1431
22. Faber MJ, Bosscher RJ, Chin APMJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch Phys Med Rehabil. 2006;87:885-896
23. Takeshima N, Rogers ME, Islam MM, Yamauchi T, Watanabe E, Okada A. Effect of concurrent aerobic and resistance circuit exercise training on fitness in older adults. Eur J Appl Physiol. 2004;93:173-182
24. Camargo MD, Stein R, Ribeiro JP, Schvartzman PR, Rizzatti MO, Schaan BD. Circuit weight training and cardiac morphology: A trial with magnetic resonance imaging. Br J Sports Med. 2008;42:141-145; discussion 145
25. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. American college of sports medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510-1530
26. Sattelmair JR, Pertman JH, Forman DE. Effects of physical activity on cardiovascular and noncardiovascular outcomes in older adults. Clin Geriatr Med. 2009;25:677-702, viii-ix
27. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. 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;39:1435-1445
28. Seynnes O, Fiatarone Singh MA, Hue O, Pras P, Legros P, Bernard PL. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. J Gerontol A Biol Sci Med Sci. 2004;59:503-509
29. Ahmed N, Mandel R, Fain MJ. Frailty: An emerging geriatric syndrome. Am J Med. 2007;120:748-753
30. Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID. Frailty intervention trial (fit). BMC Geriatr. 2008;8:27
31. van den Beld AW, Lamberts SW. The male climacterium: Clinical signs and symptoms of a changing endocrine environment. Prostate Suppl. 2000;10:2-8
32. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-495
33. 曾明月, 徐亞瑛. 老人衰弱之概念分析. 護理雜誌. 2008;55:80-85
34. Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769-1775
35. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The i.A.N.A task force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12:29-37
36. Ottenbacher KJ, Ostir GV, Peek MK, Snih SA, Raji MA, Markides KS. Frailty in older mexican americans. J Am Geriatr Soc. 2005;53:1524-1531
37. Hirsch C, Anderson ML, Newman A, Kop W, Jackson S, Gottdiener J, Tracy R, Fried LP. The association of race with frailty: The cardiovascular health study. Ann Epidemiol. 2006;16:545-553
38. Ble A, Cherubini A, Volpato S, Bartali B, Walston JD, Windham BG, Bandinelli S, Lauretani F, Guralnik JM, Ferrucci L. Lower plasma vitamin e levels are associated with the frailty syndrome: The inchianti study. J Gerontol A Biol Sci Med Sci. 2006;61:278-283
39. Avila-Funes JA, Helmer C, Amieva H, Barberger-Gateau P, Le Goff M, Ritchie K, Portet F, Carriere I, Tavernier B, Gutierrez-Robledo LM, Dartigues JF. Frailty among community-dwelling elderly people in france: The three-city study. J Gerontol A Biol Sci Med Sci. 2008;63:1089-1096
40. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009;64:675-681
41. Cherniack EP, Florez HJ, Troen BR. Emerging therapies to treat frailty syndrome in the elderly. Altern Med Rev. 2007;12:246-258
42. Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, Zeger SL, Fried LP. Phenotype of frailty: Characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61:262-266
43. Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;166:418-423
44. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;2:1
45. Mitnitski AB, Mogilner AJ, MacKnight C, Rockwood K. The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev. 2002;123:1457-1460
46. Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004;52:1929-1933
47. Jones D, Song X, Mitnitski A, Rockwood K. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly canadians. Aging clinical and experimental research. 2005:465-471
48. Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: Lessons from the cardiovascular health study. J Am Geriatr Soc. 2008;56:898-903
49. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24
50. Mitnitski AB, Song X, Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004;59:M627-632
51. Woo J, Goggins W, Sham A, Ho SC. Public health significance of the frailty index. Disabil Rehabil. 2006;28:515-521
52. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62:722-727
53. Kulminski A, Yashin A, Arbeev K, Akushevich I, Ukraintseva S, Land K, Manton K. Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: Results from analyses of the national long term care survey. Mech Ageing Dev. 2007;128:250-258
54. Woo J, Goggins W, Sham A, Ho SC. Social determinants of frailty. Gerontology. 2005;51:402-408
55. Chin APMJ, de Groot LC, van Gend SV, Schoterman MH, Schouten EG, Schroll M, van Staveren WA. Inactivity and weight loss: Effective criteria to identify frailty. J Nutr Health Aging. 2003;7:55-60
56. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med. 2002;347:1068-1074
57. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556-561
58. Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P. Overview of the mna--its history and challenges. J Nutr Health Aging. 2006;10:456-463; discussion 463-455
59. Ottenbacher KJ, Graham JE, Al Snih S, Raji M, Samper-Ternent R, Ostir GV, Markides KS. Mexican americans and frailty: Findings from the hispanic established populations epidemiologic studies of the elderly. Am J Public Health. 2009;99:673-679
60. Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett-Connor E, Orwoll ES. Frailty in older men: Prevalence, progression, and relationship with mortality. J Am Geriatr Soc. 2007;55:1216-1223
61. Blyth FM, Rochat S, Cumming RG, Creasey H, Handelsman DJ, Le Couteur DG, Naganathan V, Sambrook PN, Seibel MJ, Waite LM. Pain, frailty and comorbidity on older men: The champ study. Pain. 2008;140:224-230
62. Goggins WB, Woo J, Sham A, Ho SC. Frailty index as a measure of biological age in a chinese population. J Gerontol A Biol Sci Med Sci. 2005;60:1046-1051
63. Chen CY, Wu SC, Chen LJ, Lue BH. The prevalence of subjective frailty and factors associated with frailty in taiwan. Arch Gerontol Geriatr. 2010;50 Suppl 1:S43-47
64. Hennessey JV, Chromiak JA, DellaVentura S, Reinert SE, Puhl J, Kiel DP, Rosen CJ, Vandenburgh H, MacLean DB. Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people. J Am Geriatr Soc. 2001;49:852-858
65. Maggio M, Cappola AR, Ceda GP, Basaria S, Chia CW, Valenti G, Ferrucci L. The hormonal pathway to frailty in older men. J Endocrinol Invest. 2005;28:15-19
66. Mohr BA, Bhasin S, Kupelian V, Araujo AB, O'Donnell AB, McKinlay JB. Testosterone, sex hormone-binding globulin, and frailty in older men. J Am Geriatr Soc. 2007;55:548-555
67. Cawthon PM, Ensrud KE, Laughlin GA, Cauley JA, Dam TT, Barrett-Connor E, Fink HA, Hoffman AR, Lau E, Lane NE, Stefanick ML, Cummings SR, Orwoll ES. Sex hormones and frailty in older men: The osteoporotic fractures in men (mros) study. J Clin Endocrinol Metab. 2009;94:3806-3815
68. Solerte SB, Gazzaruso C, Bonacasa R, Rondanelli M, Zamboni M, Basso C, Locatelli E, Schifino N, Giustina A, Fioravanti M. Nutritional supplements with oral amino acid mixtures increases whole-body lean mass and insulin sensitivity in elderly subjects with sarcopenia. Am J Cardiol. 2008;101:69E-77E
69. Dhesi JK, Jackson SH, Bearne LM, Moniz C, Hurley MV, Swift CG, Allain TJ. Vitamin d supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004;33:589-595
70. Gotshalk LA, Kraemer WJ, Mendonca MA, Vingren JL, Kenny AM, Spiering BA, Hatfield DL, Fragala MS, Volek JS. Creatine supplementation improves muscular performance in older women. Eur J Appl Physiol. 2008;102:223-231
71. Gotshalk LA, Volek JS, Staron RS, Denegar CR, Hagerman FC, Kraemer WJ. Creatine supplementation improves muscular performance in older men. Med Sci Sports Exerc. 2002;34:537-543
72. Flakoll P, Sharp R, Baier S, Levenhagen D, Carr C, Nissen S. Effect of beta-hydroxy-beta-methylbutyrate, arginine, and lysine supplementation on strength, functionality, body composition, and protein metabolism in elderly women. Nutrition. 2004;20:445-451
73. Frimel TN, Sinacore DR, Villareal DT. Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Med Sci Sports Exerc. 2008;40:1213-1219
74. Hiroyuki S, Uchiyama Y, Kakurai S. Specific effects of balance and gait exercises on physical function among the frail elderly. Clin Rehabil. 2003;17:472-479
75. Inokuchi S, Matsusaka N, Hayashi T, Shindo H. Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: A multi-centre controlled trial. J Rehabil Med. 2007;39:479-485
76. Justine M, Hamid TA. A multicomponent exercise program for institutionalized older adults. J Gerontol Nurs.1-10
77. Landi F, Onder G, Carpenter I, Cesari M, Soldato M, Bernabei R. Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study. J Clin Epidemiol. 2007;60:518-524
78. Taguchi N, Higaki Y, Inoue S, Kimura H, Tanaka K. Effects of a 12-month multicomponent exercise program on physical performance, daily physical activity, and quality of life in very elderly people with minor disabilities: An intervention study. J Epidemiol. 2010;20:21-29
79. Wolf SL, Sattin RW, O'Grady M, Freret N, Ricci L, Greenspan AI, Xu T, Kutner M. A study design to investigate the effect of intense tai chi in reducing falls among older adults transitioning to frailty. Control Clin Trials. 2001;22:689-704
80. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. J Am Geriatr Soc. 2003;51:1794-1803
81. Lan C, Lai JS, Wong MK, Yu ML. Cardiorespiratory function, flexibility, and body composition among geriatric tai chi chuan practitioners. Arch Phys Med Rehabil. 1996;77:612-616
82. Ota A, Yasuda N, Horikawa S, Fujimura T, Ohara H. Differential effects of power rehabilitation on physical performance and higher-level functional capacity among community-dwelling older adults with a slight degree of frailty. J Epidemiol. 2007;17:61-67
83. Daniels R, van Rossum E, de Witte L, Kempen GI, van den Heuvel W. Interventions to prevent disability in frail community-dwelling elderly: A systematic review. BMC Health Serv Res. 2008;8:278
84. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. Lancet. 2008;371:725-735
85. American college of sports medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 1998;30:992-1008
86. English CK, Hillier SL, Stiller KR, Warden-Flood A. Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: A controlled trial. Arch Phys Med Rehabil. 2007;88:955-963
87. Blundell SW, Shepherd RB, Dean CM, Adams RD, Cahill BM. Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4-8 years. Clin Rehabil. 2003;17:48-57
88. Kamahara K, Homma T, Naito A, Matsumura T, Nakayama M, Kadono K, Kai S, Inoue M, Satoh H, Sekizawa K. Circuit training for elderly patients with chronic obstructive pulmonary disease: A preliminary study. Arch Gerontol Geriatr. 2004;39:103-110
89. Beckers PJ, Denollet J, Possemiers NM, Wuyts FL, Vrints CJ, Conraads VM. Combined endurance-resistance training vs. Endurance training in patients with chronic heart failure: A prospective randomized study. Eur Heart J. 2008;29:1858-1866
90. Blumenthal JA, Matthews K, Fredrikson M, Rifai N, Schniebolk S, German D, Steege J, Rodin J. Effects of exercise training on cardiovascular function and plasma lipid, lipoprotein, and apolipoprotein concentrations in premenopausal and postmenopausal women. Arterioscler Thromb. 1991;11:912-917
91. Bhambhani Y, Rowland G, Farag M. Effects of circuit training on body composition and peak cardiorespiratory responses in patients with moderate to severe traumatic brain injury. Arch Phys Med Rehabil. 2005;86:268-276
92. Jacobs PL, Mahoney ET, Nash MS, Green BA. Circuit resistance training in persons with complete paraplegia. J Rehabil Res Dev. 2002;39:21-28
93. Nash MS, Jacobs PL, Woods JM, Clark JE, Pray TA, Pumarejo AE. A comparison of 2 circuit exercise training techniques for eliciting matched metabolic responses in persons with paraplegia. Arch Phys Med Rehabil. 2002;83:201-209
94. DeGroot DW, Quinn TJ, Kertzer R, Vroman NB, Olney WB. Circuit weight training in cardiac patients: Determining optimal workloads for safety and energy expenditure. J Cardiopulm Rehabil. 1998;18:145-152
95. Salbach NM, Mayo NE, Higgins J, Ahmed S, Finch LE, Richards CL. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil. 2001;82:1204-1212
96. Topolski TD, LoGerfo J, Patrick DL, Williams B, Walwick J, Patrick MB. The rapid assessment of physical activity (rapa) among older adults. Prev Chronic Dis. 2006;3:A118
97. 周雨潔. 座椅輔助運動介入對日間照顧中心老年人肌耐力與柔軟度之影響研究. 休閒與運動管理碩士班. 2008;碩士:110
98. 吳晞瑗. 座椅式彼拉提斯介入對年輕老人姿勢平衡之影響研究. 舞蹈碩士班. 2007;碩士:97
99. Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (pase): Development and evaluation. J Clin Epidemiol. 1993;46:153-162
100. 吳佳儀. 社區老人睡眠品質與身體活動、憂鬱之相關性探討. 護理學研究所. 2001;碩士:121
101. Hagiwara A, Ito N, Sawai K, Kazuma K. Validity and reliability of the physical activity scale for the elderly (pase) in japanese elderly people. Geriatr Gerontol Int. 2008;8:143-151
102. Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The physical activity scale for the elderly (pase): Evidence for validity. J Clin Epidemiol. 1999;52:643-651
103. D'Ath P, Katona P, Mullan E, Evans S, Katona C. Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item geriatric depression scale (gds15) and the development of short versions. Fam Pract. 1994;11:260-266
104. Miyatani M, Kanehisa H, Masuo Y, Ito M, Fukunaga T. Validity of estimating limb muscle volume by bioelectrical impedance. J Appl Physiol. 2001;91:386-394
105. Yoshikazu Y, Yoshiyuki M, Sawako H, Yoko T, Ryo M, Toshikazu Y, Hisataka M, Tsutomu H, Takao H, Kazuhisa T. Japanese anthropometric reference data - special emphasis on bioelectrical impedance analysis of muscle mass. Japanese Society of Anti-Aging Medicine. 2008; 5:63-72
106. Bohannon RW, Schaubert KL. Test-retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18:426-427, quiz 428
107. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9:222-226
108. Zak M, Swine C, Grodzicki T. Combined effects of functionally-oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial). BMC Public Health. 2009;9:39
109. Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and tinetti balance measures in community-dwelling older people. J Am Geriatr Soc. 2004;52:1343-1348
110. Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: A marker of physical frailty. J Am Geriatr Soc. 1992;40:203-207
111. Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, Newman AB. The 6-min walk test: A quick measure of functional status in elderly adults. Chest. 2003;123:387-398
112. Toraman NF, Erman A, Agyar E. Effects of multicomponent training on functional fitness in older adults. J Aging Phys Act. 2004;12:538-553
113. Espinoza SE, Hazuda HP. Frailty in older mexican-american and european-american adults: Is there an ethnic disparity? J Am Geriatr Soc. 2008;56:1744-1749
114. Sattin RW, Easley KA, Wolf SL, Chen Y, Kutner MH. Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. J Am Geriatr Soc. 2005;53:1168-1178
115. Wolf SL, O'Grady M, Easley KA, Guo Y, Kressig RW, Kutner M. The influence of intense tai chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults. J Gerontol A Biol Sci Med Sci. 2006;61:184-189
116. Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID. A randomized, controlled trial of quadriceps resistance exercise and vitamin d in frail older people: The frailty interventions trial in elderly subjects (fitness). J Am Geriatr Soc. 2003;51:291-299
117. Wood RH, Reyes R, Welsch MA, Favaloro-Sabatier J, Sabatier M, Matthew Lee C, Johnson LG, Hooper PF. Concurrent cardiovascular and resistance training in healthy older adults. Med Sci Sports Exerc. 2001;33:1751-1758
118. Maiorana A, O'Driscoll G, Cheetham C, Collis J, Goodman C, Rankin S, Taylor R, Green D. Combined aerobic and resistance exercise training improves functional capacity and strength in chf. J Appl Physiol. 2000;88:1565-1570
119. Welle S, Totterman S, Thornton C. Effect of age on muscle hypertrophy induced by resistance training. J Gerontol A Biol Sci Med Sci. 1996;51:M270-275
120. Bouchla A, Karatzanos E, Dimopoulos S, Tasoulis A, Agapitou V, Diakos N, Tseliou E, Terrovitis J, Nanas S. The addition of strength training to aerobic interval training: Effects on muscle strength and body composition in chf patients. J Cardiopulm Rehabil Prev. 2010