臺灣博碩士論文加值系統

本研究目的在探討高齡者在整合性運動訓練後再停止訓練對認知功能與身體功能之影響。受試者以在長期照護中心的43位高齡者為對象，將其隨機分配成運動組與控制組，運動參與為期5個月、每週兩次的整合性運動課程並停止訓練3個月。運動訓練課程介入前（B）、訓練後（AT）、停止訓練（AD）均進行日常生活活動量表、簡易失智量表和功能性體適能項目檢測。測驗結果以多因子重複量數進行統計分析，所有數據以平均值±標準差來呈現，顯著差異訂為p＜.05。結果發現經過5個月的整合性運動可改善身體功能與認知功能的表現，但在3個月的停止訓練後卻無法維持其效益。由此可知，高齡者參與5個月的整合性運動訓練可改善身體功能與認知功能，而在停止訓練中，肌力為影響身體功能的主要因素，因此，要改善並維持高齡者的身體功能與認知功能應進行結合有氧與肌力訓練的整合性運動。

Purpose：The purpose of the present study was to investigate the effect of 5-month integrated exercise and 3-month detraining on the cognitive functional and functional fitness of old people. Methods: Forty-three older people were randomly assigned to an exercise (n = 21) or a control group (n = 22). The exercise group participated integrated exercise training, twice weekly for 5-month. Control group maintained ordinary lifestyle. All participants were underwent the test of activity of daily living（ADL）, mini-mental state examination（MMSE）, and functional fitness before training (B), after training (AT) and after detraining (AD). All data was analyzed by Multi-factor repeated measures. Results: Cognitive functional and functional fitness improved during the exercise training period. The components of functional fitness most affected by detraining were lower physical activity after 3-months of detraining. Conclusion: The results of this study highlight the negative effects of interrupting exercise on several physical parameters of functional fitness.

目錄
目錄 IV
表目錄 V
圖目錄 VI
第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 2
第三節　研究假設 2
第二章　文獻探討 3
第一節　失智症之介紹 3
第二節　失智症對日常生活活動與身體功能之探討 5
第三節　停止訓練對身體功能之探討 7
第四節　總結 8
第三章　研究方法 10
第一節　研究架構 10
第二節　研究對象 10
第三節　實驗時間與地點 11
第四節　實驗流程與步驟 12
第五節　資料處理與分析 16
第四章　結果 17
第一節　運動組與控制組的基本生理值 17
第二節 運動組與控制組訓練後與停止訓練的功能性體適能與認知功能之比較 18
第五章　討論 22
第一節　整合性運動對身體功能與認知功能之影響 22
第二節　停止訓練對身體功能與認知功能之影響 25
第六章　結論與建議 26
第一節　研究結論 26
第二節　研究限制 26

參考文獻 28
中文部份 28
英文部分 29
附錄 38
ADL日常生活活動量表 38
MMSE簡易智能量表 39
受試者暨家屬同意書 40

參考文獻
中文部分
王駿濠、蔡佳良（2009）。 以運動與身體活動預防失智症：文獻回顧。臺灣公共衛生雜誌，28卷4期。
徐榮隆、陳威宏、邱浩彰、沈幸梅（2000）不同時期失智症之認知功能。台灣醫學，4，371-378。
財團法人體力創造指導協會（2004）。高齡者體力創造支援士。日本：財團法人體力創造指導協會。
李懷芬﹙2003﹚。護理失智病患及其主要照顧者之經驗。榮總護理， 20卷3期，262-269。
陸秀芳﹙2004﹚。應用Rogers護理理論於一位失智症患者。慈濟護理雜誌，3卷2期，91-97。
邱銘章、湯麗玉（2009）。失智症照護指南。台北市：原水文化。
邱逸榛、何玉婷、陳婉庭、徐亞瑛﹙2004﹚。簡介阿茲海默氏症與其照護。長期照護雜誌，7卷4期，289-304。

英文部分
Ahlskog, J. E., Geda, Y. E., Graff-Radforf, N. R., Petersen, R. (2011) Physical Exercise as a Preventive or Diease-Modifying Treatment of Dementia and Brain Aging. Mayo Clinic Proceeding, 86(9), 876-884.
ACSM: American college of sports medicine position stand.(1998) Exercise and physical activity for older adults. Medicine Science Sports Exercise ,30, 992–1008.
Booth, F.W., Gordon, S. E., Carlson, C. J., Hamilton, M. T. (2000) Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol, 88, 774-87.
Black, J. E., Isaacs, K. R., Anderson, B. J., Alcantara , A. A., Greenough, W. T. (1990) Learning causes synaptogenesis, whereas motor act ivi ty causes angiogenesis, in cerebellar cortex of adult rats. Proc Natl Acad Sci, 87, 5568-5572.
Blankevoort, C. G., Heuvelen, M. J., Boersma, F., Luning, H., Jong, J., Scherder, E. J.(2010) Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia and Geriatric Cognitive Disorders, 30(5), 392-402.
Binder, E. F., Schechtmann, K. B., Ehsani, A. A., Steger-May, K., Brown, M., Sinacore, D. R., Yarasheski, K. E., Holloszy, J. O.(2002) Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. Journal of the American Geriatrics Society, 50, 1921–1928.
Churchill, J. D., Colcombe, S., Kramer, A. F., Greenough, W. T.(2002) Exercise, experience and the aging brain. Neurobiology of aging, 23(5), 941-55.
Colcombe, S., Kramer, A. F.(2003) Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci,14(2),125–130.
Churchill, J. D., Galvez, R., Colcombe, S., Swain, R. A., Kramer, A. F., Greenough, W, T. (2002) Exercise, experience and the aging brain. Neurobiology of aging, 23, 941–955.
Christofoletti, G., Oliani, M.M., Gobbi, S., Stella, F., Bucken Gobbi, L.T., Renato Canineu, P.( 2008) A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Clinical Rehabilitation, 22(7), 618-26.
Colcombe, S. J., Erickson, K. I., Raz, N. (2003) Aerobic fitness reduces brain tissue loss in aging humans. Journal Gerontol A Biological Society Medicine Society, 58 (2), 176–180
Colcombe, S., Kramer, A. F., Erickson, K. I. (2004) Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci , 101, 3316-3321.
Carvalho, M. J., Marques, E. Mota, J. (2009) Training and Detraining Effects on Functional Fitness after a Multicomponent Training in Older Women. Gerontology, 55(1).
Carmeli, E., Reznick, A. Z., Coleman, R., Carmeli, V.(2000) Muscle strength and mass of lower extremities in relation to functional abilities in elderly adults. Gerontology , 46,249–257.
Churchill, J. D., Galvez, R., Colcombe, S., Swain, R. A., Kramer, A. F., Greenough, W. T. (2002) Exercise, experience and the aging brain. Neurobiology of aging, 23, 941–955.
Dudley, G. A., &; Snyder, L. L. (1998). Deconditioning and bed rest: musculoskeletal response. In J. L. Roitman (Ed.), ACSM’s resource manual. Philadelphia: Lippincott Williams &; Wilkins.
Elliott, K. J., Sale, C., Cable, N. T. (2002) Effects of resistance training and detraining on muscle strength and blood lipid profiles in postmenopausal women. British Journal of Sports Medicine, 36, 340–4.
Erickson, K. I., Prakash, R. S., Voss, M. W. (2009) Aerobic fitness is associated with hippocampal volume in elderly humans. Hippocampus, Epub ahead of print.
Ellen L, M., Valerie, E, K., Rebecca, G, L., Susan, M, M., Barbara, B, C., Joyce, M, E., Linda, T. (2011) American Physical Therapy Association, 91, 1198–1207.
Fuh, J. L.（2006）. Study of behavioral and psychological symptoms of dementia in Taiwan. Acta neurologica Taiwanica, 15 (3), 154-60.
Feldman, H. H., Baelen, V. B., Kavanagh, S. M., Torfs, K. E. L. (2005) Cognition, function, and caregiving time patterns in patients with mildto - moderate Alzheimer disease: a 12 month analysis. Alzheimer Disease and Associated Disorders, 19, 29–36.
Gaugler , J. E., Duval, S. , Anderson, K. A., Kane, R. L.(2007) Predicting nursing home admission in the US: a meta-analysis. BMC geriatrics, 7, 13.
Gül, Y. Ö., Hülya, A., Füsun, N. T., Ferah, K., Özgür, Ö., ＆ Vedat, C.（2005）. Effect Of Strength And Endurance Training On Cognition In Older People. Journal of Sports Science and Medicine , 4, 300-313.
Hendrie, H. C.（1988）. Epidemiology of dementia and Alzheimer’s disease. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 6, 3-18.
Henwood, T. R., Taaffe, D.R. (2008) Detraining and retraining in older adults following long-term muscle power or muscle strength specific training. The journals of gerontology. Series A, Biological sciences and medical sciences, 63
(7), 751-8.
Hauke, R., Heekeren, M. P. (2011) Cardiovascular and coordination training differentially improve cognitive performance and neural processing in older adults. Frontiers in Human Neuroscience,26, 1-12.
Hallage, T., Krause, M. P., Haile, L., Miculis, C. P., Nagle, E. F., Reis, R. S., Da Silva, S. G. (2010) The effects of 12 weeks of step aerobics training on functional fitness of elderly women. Journal of strength and conditioning research / National Strength &; Conditioning Association, 24(8), 2261-6.
Kalapotharakos, V. I., Diamantopoulos, K., Tokmakidis, S. P. (2010) Effects of resistance training and detraining on muscule strength and functional performance of older adults aged 80 to 88 years. Aging Clinic Exp Res, 22(2), 134-140.
Kwak, Y. S., Um, S. Y., Son, T. G., Kim, D. J.(2008) Effect of regular exercise on senile dementia patients. International journal of sports medicine,29(6),471-4.
Kuiack,S.L., Campbell, W. W., Evans, W. J. (2004) A structured resistive training program improves muscle strength and power in elderly persons with dementia. Activities Adaptation Aging ,28, 35-47.
Larson, E. B., Wang, L., Bowen, J. D., McCormick, W. C., Teri, L., Crane, P., et al.（2006）. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of internal medicine, 144 (2), 73-81.
Liu-Ambrose, T. Nagamatsu, L. S., Graf, P. Beattie, B. L., Ashe, M. C., Handy, T. C. (2010) Resistance training and executive function: a 12-month randomized controlled trial. Arch Intervention Medicine, 170, 170-178.
Lord, S. R., Murray, S. M., Chapman, K., Munro, B., Tiedemann, A. (2002) Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. Journal Gerontol. A Biological Society Medicine Society, 57, 539-543.
Larsson, L (1983) Histochemical characteristics of human skeletal muscle during aging. Acta Physiol Scand, 117, 469–471.
Mechling, H.（2008）. Dementia and physical activity. European Review of Aging and Physical Activity, 5, 1–3.
Porter, M. M., Nelson, M. E., Singh, M. A. F., Layne, J. E., Morganti, C. M., Trice, I., et al.( 2002) Effects of long-term resistance training and detraining on strength and physical activity in older women. Journal of aging and physical activity, 10, 260–70.
Pereira, A.C., Huddleston, D.E., Brickman, A.M., Sosunov, A.A., Hen, R., McKhann, G.M., Small, S.A. (2007). An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proceedings of the National Academy of Sciences of the United States of America, 104(13), 5638-5643.
Patrylo, P.R., &; Williamson, A. (2007). The effects of aging on dentate circuitry and function. Progress in Brain Research, 163, 679-696.
Rolland, Y., Pillard, F., Klapouszczak, A., Reynish, E., Thomas, D., Andrieu, S., Rivière, D., ＆ Vellas, B.（2007）. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. Journal of the American Geriatrics Society, 55(2), 158-65.
Rogers, R. L., Meyer, J. S., Mortel, K. F. (1990) After reaching retirement age physical activity sustains cerebral perfusionand cognition. J Am Geriatr Soc, 38, 123-128.
Rikli RE, Jones CJ. Functional fitness normative scores for community-residing older adults, ages 60–94.(1999) Journal of Aging and Physical Activity ,7, 162–181.
Rosenzweig, E.S., &; Barnes, C.A. (2003). Impact of aging on hippocampal function: Plasticity, network dynamics, and cognition. Progress in Neurobiology,69(3), 143-179.
Rikli , R. E., Jones, C. (1999) Functional fitness normative scores for community-residing older adults, ages 60–94. Journal of Aging and Physical Activity , 7, 162–181.
Sforzo, G. A., McManis, B. G., Black, D., Luniewski, D., Scriber, K. C. (1995) Resilience to exercise detraining in healthy older adults. Journal of the American Geriatrics Society, 43, 209–215.
Shubert, T. E., Schrodt, L. A., Mercer, V. S., Busby-Whitehead, J., Giuliani, CA. (2006) Are scores on balance screening tests associated with mobility in older adults? Geriatrics of the American Physical Therapy Association, 29, 35-39.
Santana-Sosa, E., Barriopedro, M. I., López-Mojares, L. M., Pérez, M., ＆ Lucia, A.（2008）. Exercise training is beneficial for Alzheimer's patients. International journal of sports medicine, 29 (10), 845-850.
Smith, K., Winegard, K., Hicks, A. L., McCartney, N. (2003) Two years of resistance training in older men and women: the effects of three years of detraining on the retention of dynamic strength. Canadian Journal of Applied Physiology, 28, 462–474.
Silsupadol, P., Shumway-Cook, A., Lugade, V. (2009) Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Physical Medicine Rehabilitation, 90, 381-387.
Silsupadol, P., Lugade, V., Shumway-Cook, A., (2009). Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Gait Posture, 29, 634-639.
Toraman, N. F., Ayceman, N. (2005) Effects of six weeks of detraining on retention of functional fitness of old people after nine weeks of multicomponent training. British Journal of Sports Medicine, 39, 565–568.　
Toraman, N. F. (2005) Short term and long term detraining:Is there any difference between young-old and old people? British Journal of Sports Medicine, 39, 561–564.　
Takata, Y. T., Ansai, I. S., Kimura ,Y. Y.,Yoshitake K. S. (2008) Physical Fitness and Cognitive Function in an 85-Years-Old Community-Dwelling Population. Gerontology, 54, 354-360.
Thomas, V. S., Hageman, P. A.(2003) Can neuromuscular strength and functioning people with dementia be rehabilitated using resistance exercise training? Results from a preliminary intervention study. Journals of Gerontology Series, 58, 746–751.
van Schoor, N. M., Smit, J. H., Pluijm, S. M., Jonker, C., Lips, P. (2002) Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. Journal Clinic Epidemiologic, 55, 855-862.