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研究生:陳銘樹
研究生(外文):Ming-Shu Chen
論文名稱:環狀油壓阻力訓練對於慢性病中老年人的平衡功能影響之研究
論文名稱(外文):The effect of circuit hydraulic resistance training on postural stabilityin elderly, chronically ill patients
指導教授:陳啟光陳啟光引用關係
指導教授(外文):Chi-Kuang Chen
口試委員:江行全林久翔孫天龍林瑞豐
口試委員(外文):Bernard C. JiangChiuhsiang Joe LinTien-Lung SunJui-Feng Lin
口試日期:2014-12-29
學位類別:博士
校院名稱:元智大學
系所名稱:工業工程與管理學系
學門:工程學門
學類:工業工程學類
論文種類:學術論文
畢業學年度:103
語文別:中文
論文頁數:105
中文關鍵詞:阻力訓練跌倒壓力中心點:COP多元多尺度熵:MMSE中老年人慢性病患
外文關鍵詞:Resistance TrainingFallCenter of Pressure (COP)Multivariate Multiscale Entropy (MMSE)Elderly PeopleChronically Ill Patients
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在全球人口快速老化的趨勢下,如何有效維持並提升中、高齡長者的日常功能性活動以避免跌倒,進而增進中老年人的健康以降低醫療支出成本已成為各國全人照護之重要議題。隨著年齡增長,感覺系統功能中的肌肉骨骼系統也會逐漸退化,使得肌力下降、肌纖維數目減少以及運動控制能力降低,而這些問題對於平衡的控制及恢復影響甚鉅,相關的研究指出,年齡越大之長者,其跌倒發生率與所帶來後遺症也隨之增加。

本研究目的在於發展一套有效的運動計劃來提升中、高齡慢性病患(包含心血管疾病、糖尿病與骨質疏鬆症的患者)的步態平衡功能以避免跌倒,研究主要探討介入一定程度的環狀油壓阻力訓練並搭配有氧運動與中、老年人的平衡感能力改善的相關性。此外,近期相關研究以多尺度熵(MSE)演算法分析站立時身體晃動軌跡圖的中心壓力點(COP)數據所計算出的複雜度(CI)指標,已被廣放的應用於測量身體平衡感或晃動程度,而以較進階的多元多尺度熵(MMSE)演算法的應用並不多見,本研究除了應用臨床常見的傳統平衡感測量指標(如起步走測試、睜眼單足立等),我們也應用了MSE與MMSE演算法所計算出的平衡感指標來評估介入運動計畫前、後的改善差異,並藉此探討MMSE演算法的鑑別度是否優於MSE,甚或可替代傳統臨床使用的平衡感指標而被更廣泛的應用臨床研究上。

本研究招募45歲以上之中、高齡慢性病患,自願參與且完成全程計畫者共計54名(47-89歲);包含介入12週阻力運動訓練與完整測量的運動組25名,以及提供運動衛教光碟片,並建議其在家自我居家運動並完成量測的控制組共29名,研究對象平均年齡為67.56歲 ± 10.70歲,且所有的病患在參與研究前均已簽署臨床試驗倫理委員會(IRB)所核定的受測者同意書(編號:FEMH-IRB-101029-E, v. 02)。

研究方法是利用環狀訓練方式,結合油壓阻力訓練器材與有氧登階活動,進行每週三次,共計12週之運動介入,同時並徵召相近年齡與族群之衛教組作為對照組。分別於運動前、運動後六週,與十二週運動後進行平衡力測量,並再進而監控停止訓練四週後的平衡力,所有資料將以配對T檢定與重覆量數變異數分析法進行平均數之比較,顯著水平為0.05。

研究結果顯示,規律的油壓阻力訓練搭配有氧運動有助於提升中、老年慢性病患的步態平衡功能,根據研究數據顯示,多數的平衡感指標呈現出統計上的顯著差異,運動組介入訓練前後,起步走測試從7.67秒減少到6.76秒(p值= 0.00013),MMSE的複雜度CI值從13.87增加到14.83(p值= 0.0094),且不管是運動組或對照組,女性在訓練前、後的改善效果顯著比男性好(p值= 0.0008);我們也同時發現,應用較新的MMSE演算法分析壓力中心點COP的晃動軌跡數據所得到的複雜度CI指標優於MSE演算法所得到的CI值與其他傳統的COP測量分析平衡感指標。

最後,我們認為,以油壓阻力訓練搭配有氧運動的規律鍛煉方式,應可提升中老年慢性病患的步態平衡功能和姿勢穩定感,對於中齡患者的訓練成效應該優於高齡患者;女性的訓練效果也應該比男性好,且規律地運動有助於預防中、老年病患因跌倒所造成的傷害。因此,我們建議在老齡化的社區裡,政府和醫院都應加強宣導並鼓勵中、高齡的慢性病患者能夠經常自我鍛煉並規律運動。
As the global population ages rapidly, maintaining and increasing the activities of daily living and reducing the cost of medical care for elderly people are critical for holistic health care worldwide. With the increase of age, lower limb muscle degeneration reduces balance ability, which can easily lead to person falls. Studies have suggested that falling and its sequelae can substantially influence elderly people.

This study aimed to develop an effective exercise training program for enhancing the gait function of chronically ill (including cardiovascular disease, diabetes, and osteoporosis) patients to avoid falls and to determine the relationship between regular hydraulic resistance training with aerobic exercise intervention and postural stability in elderly people. In addition, the complexity index (CI), which is based on a multiscale entropy (MSE) algorithm, has been applied in recent studies to demonstrate a person’s adaptability to intrinsic and external perturbations, and has been widely used to measure postural sway or stability. Multivariate multiscale entropy (MMSE) is an advanced algorithm used to calculate the CI values of the center of pressure (COP) data. In this study, we used traditional clinical study indicators to measure postural stability (e.g., timed up and go, single-leg stance with eyes open) and applied the MSE and MMSE algorithms to calculate the postural sway of indicators to assess the differences before and after the intervention exercise program. In addition, we examined whether the MMSE algorithm is superior to the MSE algorithm, whether it can replace traditional clinical indicators, and whether it is more widely used.

The participants were chronically ill patients older than 45 years (47–89 years old); 25 participants in the exercise group completed the 12-week training regimen and assessment, and 29 participants in the control group completed a self-exercise at home. The average age of the participants in the intervention group was 67.56 ± 10.70 years. All patients in this study signed institutional review board (IRB) agreements before participating (IRB approval no.: FEMH-IRB-101029-E, v. 02, date: 20120429).

This study involved a circuit exercise that combined the use of hydraulic resistance training equipment and aerobic stepping. The participants completed the exercise three times a week for a total of 12 weeks. In addition, the present study recruited a matched age and gender group as the control group. The assessment of balance was conducted four times: pre-exercise, post-Week-6, post-Week-12, and during detraining (post-Week-4 after the exercise training was completed). All data were analyzed using repeated measurements in a paired t test or analysis of variance. The significance level was 0.05.

The results revealed the beneficial effects of regular aerobic and resistance training, which improved postural stability in elderly and chronically ill patients. According to our data, most of the postural stability measurements exhibited significant differences between the exercise group and control group. The duration of the timed up and go test decreased from 7.67 s to 6.76 s (p = 0.00013), and the CI of the MMSE increased from 13.87 to 14.83 (p = 0.0094). Women exhibited more significant differences than did men in the exercise and control groups (p = 0.0008). We also found that the MMSE method was superior in COP detection because its discriminatory ability was superior to that of the MSE method as well as other postural stability indicators and traditional balance and gait indices.

We concluded that regular exercise regimens such as aerobic, resistance, and combination exercise training enhance the gait function and postural stability in elderly and chronically ill patients. Younger patients attained more positive results than did older patients, and women attained more positive results than did men. Regular exercise might prevent falls; thus, the government and hospitals should increase related promotional measures in aging communities to encourage regular exercise among elderly and chronically ill outpatients.
目錄
中文摘要.................................................iv
Abstract................................................vi
目錄.....................................................x
表目錄...................................................xi
圖目錄...................................................xii
專有名詞縮寫.............................................xiv
第壹章 導論..............................................1
一、 背景與現況........................................1
二、 研究動機..........................................2
三、 研究目的..........................................4
四、 研究架構..........................................7
第貳章 文獻探討...........................................9
一、 老人跌倒..........................................9
二、 常見的慢性病......................................11
三、 平衡感...........................................15
四、 阻力訓練..........................................19
五、 步態平衡之分析測量工具與指標........................24
第參章 研究方法...........................................47
一、 研究對象..........................................52
二、 研究流程與設計.....................................53
三、 研究假說與工具.....................................58
四、 預期成效..........................................59
第肆章 研究結果與討論.....................................62
一、 研究結果..........................................62
二、 討論..............................................82
三、 研究限制..........................................85
第伍章 總結與後續研究.....................................88
一、 總結與啟示........................................88
二、 後續研究..........................................89
參考文獻..................................................91
附件一:人體試驗委員會(IRB)說明及同意書......................99
附件二:受試者資料收集表單.................................102
附件三:受試者型態概述.....................................103
附件四:人體臨床試驗研究成員保密協議書......................104
附件五:人體試驗委員會(IRB)審查同意試驗證明書................105
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