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研究生:廖子喬
研究生(外文):Tzu-Chiao Liao
論文名稱:結合有氧與阻力之循環訓練介入對安養機構之衰弱及衰弱前期高齡者之成效
論文名稱(外文):Effects of Combined Aerobic and Resistance Circuit Training on Physical Performance, Body Composition for the Frail and Pre-frail Elderly Living in a Residential Care Facility
指導教授:陳俊忠陳俊忠引用關係李雪楨李雪楨引用關係張谷州張谷州引用關係
指導教授(外文):Jin-Jong ChenHsuei-Chen LeeKu-Chou Chang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療暨輔助科技學系
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:英文
論文頁數:116
中文關鍵詞:衰弱及衰弱傾向老年人循環訓練身體功能身體組成安養機構
外文關鍵詞:Frail and pre-frail elderlyCircuit trainingPhysical PerformanceBody compositionResidential care facility
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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

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