臺灣博碩士論文加值系統

研究背景：
台灣在 1993 年進入高齡化社會後，在 2018 老年人口已正式進入14 %的高齡社會，面臨到老化 (aging) 所帶來的帶來的問題，隨著年齡的增長，多重生理系統功能會逐漸衰退，造成許多身體功能表徵下降及不良健康結果，心理的變化降低環境的適應能力，或造成生活品質的負面影響。運動對老年人認知功能之影響是現今炙手可熱的議題之一，運動對於老年人認知功能的幫助在執行功能上要比其他認知成分更為顯著，特別是阻力訓練對老年人又是特別重要。許多橫斷性研究發現，認知功能與身體活動量，代表執行功能表現越佳。肌力的提升才是長期運動與執行功能進步的中介者，而非攝氧量峰。發現認知功能與肌少症間存在正相關，低認知功能的人，手握力降低的速度更快，肌力是否會調節運動對執行功能的影響也需要進一步探討。
研究目的：
下列三個研究目的，1. 探討固定式阻力運動介入對老年人肌力以及認知功能之成效。2. 探討固定式阻力運動，對老年人肌力的效益。3. 探討老年人不同肌力水平在經過固定式阻力運動後，執行功能的差異。
研究方法：
本研究於台北市北投區招募滿 60歲老年人，並分為兩組，實驗組 (n=46) 進行12週的固定式阻力運動。動作設計選擇胸部推舉、滑輪下拉、腿部推蹬、腿部後勾、肩部推舉，腿部內收及外展，七個動作作為實驗介入動作。每週進行2次，每次 60 分鐘，包含 10分鐘的腳踏車/跑步機熱身，提高全身大肌肉群溫度、提高關節活動度，以避免在運動時造成的傷害。主運動為四週為一個階段，採漸進性原則，強度為50%-80% 1RM。每個動作間都做該部位肌肉伸展運動。
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控制組 (n=68) 對照實驗組的性別、年齡、教育年以及身體活動，實驗組在進行間不介入任何改變，維持平常生活習慣，在實驗介入完成後，給予阻力運動指導。兩組皆會在介入前後進行體適能檢測以及執行功能測驗。
統計分析部分，先以卡方、獨立 t 檢定說明前測無差異後，再以廣義估計方程式 (Generalized estimating equation, GEE) 比較實驗組與控制組經12週肌力運動後，控制年齡、性別後對骨骼肌百分比、脂肪量百分比、上下肢肌力之成效、執行功能測驗，並針對實驗組進行組內分析探討肌力水平高與肌力水平低兩組的執行功能差異。
研究結果：
本研究實驗組收案人數共 46 人，其中男性14位 (30.4%)，女性 32 位 (69.6%)；對照組共 68 人，其中男性 21 位 (30.9%)，女性 47 位 (69.1 %)，年齡部分，實驗組平均年齡為 69.02 ±5.44 歲，對照組為69.57 ± 5.32歲，兩組在性別、年齡、功能性體適能、執行功能測驗、身體組成等為同值性 (P > 0.05)。
經過12週的固定式阻力訓練後，實驗組在介入前之平均的骨骼肌肉重量為20.90 ± 3.7公斤，在後測全數皆提升，平均值為 21.68 ± 3.9公斤，增加 0.78 %，進步幅度為 3.73 %。對照組前測平均骨骼肌肉重量20.36 ± 3.58公斤，在後測平均值為 20.16 ± 3.69公斤，減少 0.2 ，退步幅度為 0.98 %。經GEE 分析結果，交互作用項 (組別 × 時間) 在統計上達顯著差異 (β= 1.05, P<0.001)，代表著經過十二週的阻力訓練的介入實驗組在骨骼肌百分比會有顯著的增加。
體脂肪百分比方面，實驗組在介入前之平均骨骼肌肉重量為 31.94 ± 5.45，在後測平均值為 29.28 ± 6.03，減少 2.65 %，改變幅度為 8.32 %；對照組前測平均體脂肪百分比為 32.69 ± 4.79，在後測平均值 33.40 ± 4.45，增加 0.71 % ，改變幅度為 2.17 %。經GEE分析結果，交互作用項 (組別 × 時間) 在統計上達顯著差異 (β= 3.40, P< 0.001)，代表經 GEE 預測實驗組的體脂肪百分比會有減少趨勢發生。
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功能性體適能，測量雙手握力代表上肢肌力表現，細分為右、左手握力，右手握力經GEE 分析結果，交互作用項 (組別 × 時間) 在統計上達顯著差異(β=1.46, P< 0.001)；左手在統計上也達顯著差異 (β=2.19, P< 0.001)。三十秒椅子坐站代表下肢肌力表現，經GEE 分析結果，交互作用項 (組別 × 時間) 在統計上達顯著差異 (β= 5.41, P< 0.001)。
執行功能測驗分別使用牢記先前發生的事件並將其後來發生事情聯繫起來，將訊息從感知帶到為決策的Sternberg Task以及涉及靈活性以適應變化的需求、創造力以及任務切換轉換能的Task Switch、反映受試者在管理任務時的能力以及與任務性能無關的任務無關信息的干擾的Flanker Task，這三個代表執行功能元素的測驗。結果以正確率以及反應時間表示。GEE 分析結果顯示，Sternberg Task -正確率，交互作用項 (組別 × 時間) 統計上達顯著差異 (β= 0.028, P< 0.001)。Sternberg Task-反應時間，交互作用項 (組別 × 時間) 達顯著差異 (β= -37.18, P＝0.001)；Task Switch A-正確率，交互作用項 (組別 × 時間) 統計上未達顯著差異 (β= 0.003, P=0.610)。Task Switch A-反應時間，交互作用項 (組別 × 時間) 統計上達顯著差異 (β= -35.205, P<0.001)。Task Switch B-正確率，交互作用項 (組別 × 時間) 在統計上達顯著差異 (β= 0.034, P＝0.009)。Task Switch B-反應時間，交互作用項 (組別 × 時間) 得到標準化估計β值為-57.18，表示實驗組進步-57.18毫秒的Task Switch B-反應時間，在統計上達顯著差異 (β= -57.18, P＝0.044)；Flanker Task-正確率，交互作用項 (組別 × 時間) 在在統計上達顯著差異 (β= 0.007, P=0.017)。Flanker Task-反應時間，交互作用項 (組別 × 時間) 在統計上未達顯著差異 (β= 4.065, P=0.789)。
阻力運動介入選擇結合老年人日常生活功能性做作所需之肌群為考量，分別為胸部推舉、滑輪下拉、腿部推蹬、腿部後勾、腿部內收、腿部外展以及肩部推
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舉七個動作，肌力後測皆優於前測，進步幅度分別為50.84%、40.51%、45.18%、41.17%、46.30%、46.09%及64.45%。.
進一步探討肌力與執行功能間的關係，將實驗組肌力分為肌力水平高與肌力水平低兩組，不管前測還是後測，肌力水平高組的執行功能平均得分均高於肌力水平低組，標準差觀察分散程度，肌力水平低組的分散程度有向內集中，代表著肌力水平低組的老年人，在執行功能上有更好的情況發生。比較執行功能的變化量，肌力水平低組比肌力水平高組的進步幅度來得多，表示肌力較好，執行功能表現可能也較好。
研究結論：
持續 12 週、強度60% 1 RM-80% 1 RM，以功能性動作為動作設計考量，每次2 - 3組、每週至少 2 次的阻力運動，對老年人在上下肢肌力表現分別為握力及三十秒椅子坐站有顯著進步，身體組成骨骼肌肉重量及體脂肪百分比有顯著進步，執行功能部分，測驗工作記憶能力的Sternberg Task正確率與反應時間達顯著進步，測量認知彈性及任務轉換的Task Switch正確率與反應時間達顯著進步，測量抑制控制能力的Flanker Task則皆無達顯著改善。進一步探討不同肌力水平對執行功能的效益發現，低肌力水平組的反應時間進步幅度皆優於高肌力水平組，但在正確率並無觀察到此一致結果，也就是說，阻力訓練對老年人的部分執行功能有正面的影響，特別對於肌力較低的老年人，其效果優於肌力較好的，倘若能盡早養成阻力運動的習慣，對於身體組成、上下肢肌力、執行功能等有正面的影響，如此一來才能真正避免老化所帶來的影響，落實預防以及延緩，達成活躍老化之目標。

Background: After Taiwan entered the aging society in 1993, the 2018 elderly population has officially entered 14% of the old age society, facing the problems brought about by aging. As the age increases, the functions of multiple physiological systems will gradually Recession causes many physical function characterizations to decline and poor health outcomes, and psychological changes reduce the ability of the environment to adapt, or cause negative effects on quality of life. The impact of exercise on the cognitive function of the elderly is one of the hot topics today. The function of exercise for the cognitive function of the elderly is more significant in performing functions than other cognitive components. In particular, resistance training is especially important for the elderly. Cross-sectional studies have found that cognitive function and physical activity represent better performing performance. Muscle strength is the mediator of long-term exercise and executive function improvement, rather than the oxygen uptake peak. It is found that there is a positive correlation between cognitive function and sarcopenia. People with low cognitive function have a faster rate of lower grip strength. Whether muscle strength can regulate the effect of exercise on executive function needs further investigation.
Purposes: The following three research purposes explore the effects of fixed resistance exercise intervention on muscle strength and cognitive function in the elderly, and explore the effects of fixed resistance exercise on muscle strength of the elderly. To explore the differences in executive function of different muscle strength levels in the elderly after a fixed resistance exercise.
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Method: The study recruited 60-year-olds from Beitou District, Taipei City, and divided them into two groups. The experimental group (n=46) performed a 12-week of resistance exercise. For action design choose chest press, lat pull down, leg press, leg curl, shoulder press, leg adduction and abduction. 2 times a week, 60 minutes each time, including a 10-minute bicycle/treadmill warm-up, improve the body's large muscle group temperature and improve joint mobility to avoid injury during exercise. The main movement is a four-week stage with a progressive principle with a strength of 50%-80% 1-RM. Muscle stretching exercises are performed in this part of each movement.
Control group (n=68) matching the gender, age, education year and physical activity of the experimental group. The experimental group did not intervene any changes during the operation, maintained normal habits, and gave resistance exercise guidance after the experimental intervention was completed. Both groups were tested for physical fitness before and after intervention, measured skeletal muscle mass, body fat percentage.
In the statistical analysis part, the chi-square and independent t-tests are used to indicate that there is no difference in the pre-test, and then the generalized estimating equation (GEE) is used to compare the experimental group and the control group after 12 weeks of muscle strength exercise.
Conclusion: For 12 weeks, intensity 60% 1 RM-80% 1 RM, choose functional action as the action design consideration, each time 2 - 3 groups, at least 2 times a week of resistance exercise, the upper and lower extremity muscle performance of the elderly There is a significant improvement in grip and 30-second chair sit-up, and the body composition has a significant improvement in skeletal muscle mass and body fat percentage. The executive function, Sternberg Task test memory ability and response
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time have significantly improved, measuring cognition The accuracy and response time of Task Switch for flexibility and task conversion have improved significantly, and the Flanker Task for measuring suppression control has not improved significantly. Further exploration of the effect of different muscle strength on the executive function found that the response time of the low muscle strength group was better than the high muscle strength group, but this consistent result was not observed at the correct rate, that is, resistance training It has a positive impact on the executive function of the elderly, especially for the elderly with lower muscle strength. The effect is better than the muscle strength. If the habit of resistance exercise can be developed as early as possible, the body composition, upper and lower limb muscle strength, The executive function has a positive impact, so that we can truly avoid the impact of aging, implement prevention and delay, and achieve the goal of active aging.

誌謝 ii
摘要 iii
Abstract vii
第一章 緒論 1
第一節 研究背景 1
一、高齡社會的衝擊 1
二、老化伴隨著認知功能的改變 2
三、成功老化 5
第二節 研究動機 7
第三節 研究目的 9
第二章 文獻探討 10
第一節 認知執行功能 10
第二節 阻力運動與執行功能 13
一、 運動影響大腦認知的機轉 13
二、 阻力運動對執行功能變化的成效 17
第三節 阻力訓練在生理上的成效 20
第三章 研究方法 22
第一節 研究設計與架構 22
一、 研究設計 22
二、 研究架構 22
第二節 研究問題 24
第三節 研究步驟 25
第四節 名詞解釋 28
第五節 研究對象 29
第六節 研究工具 31
第七節 名詞工具信度檢測與常模 38
第八節 資料處理與統計分析 39
第九節 研究倫理考量 40
第四章 研究結果 41
第一節 基本資料分析 41
第二節 阻力訓練後的成效分析 45
一、身體組成成效分析 72
二、功能性體適能成效 74
三、執行功能成效分析 79
三、肌肉力量成效分析 86
四、不同肌力水平對執行功能分析 87
第五章 研究討論 90
第一節 阻力訓練介入後的身體組成 90
第二節 阻力運動介入後的功能性體適能 92
一、上肢肌肉功能表現 92
二、下肢肌肉功能表現 93
第三節 阻力運動介入後的肌力提升 95
第四節 阻力運動與執行功能成效探討 97
一、 阻力運動介入後的執行功能 97
二、不同肌力水平對執行功能的差異 104
第六章 研究結論 108
第一節 結論 108
第三節 建議 110
參考資料 111

表目錄

表3-2.1、不同動作與肌肉類型其功能性活動對照表 16
表3-7.1、SFT 在測信度 (R) 38
表3-8.1、描述性統計 39
表3-8.2、推論性統計 39
表 4-1.1、實驗組、控制組基本生理值 41
表 4-1.2、身體活動量、教育年齡對照 42
表 4-1.2、年齡、性別對照 42
表 4-1.4、實驗組、對照組功能性體適能 43
表 4-1.5、實驗組、對照組執行功能測驗 44
表 4-2.1、介入前後之身體組成及功能性體適能敘述統計 46
表 4-2-2、介入前後之執行功能敘述統計 47
表 4-2.3、介入前後肌力分組之執行功能敘述統計 48
表 4-2.4、GEE成效分析結果 49
表 4-2.5、GEE成效分析結果-肌力水平 64
表 4-4.1、阻力訓練對執行功能之成效 98

圖目錄

圖2-2.1、運動對大腦的機轉 16
圖2-2.2、IGF-1對肌肉直接和間接影響 16
圖3-1.1、研究架構圖 23
圖3-1.2、研究設計 23
圖3-2.1、研究流程圖 27
圖3-6.1、執行功能測驗-Sternberg Task 35
圖3-6.2、執行功能測驗-Task Switch 36
圖3-6.3、執行功能測驗-Flanker Task 37
圖 4-2.1 骨骼肌肉重量 72
圖 4-2.2 體脂肪百分比 73
圖 4-2.3 右手握力 75
圖 4-2.4 左手握力 75
圖 4-2.5、三十秒椅子坐站 76
圖 4-2.6、八英呎繞行 77
圖 4-2.7、走路速率 78
圖 4-2.8、Sternberg Task-正確率 80
圖 4-2.9、Sternberg Task-反應時間 80
圖 4-2.10 Task Switch A-正確率 83
圖 4-2.11 Task Switch A-反應時間 83
圖 4-2.12 Task Switch B-正確率 83
圖 4-2.13 Task Switch B-反應時間 83
圖 4-2.14 Flanker Task-正確率 85
圖 4-2.15 Flanker Task-反應時間 85
圖 4-2.16 最大肌力測試 86
圖 4-2.17 前後測肌力增加幅度 86
圖 4-2.18 肌力分組與執行功能 88
圖 4-2.19 肌力分組與執行功能正確率進步幅度 89
圖 4-2.20 肌力分組與執行功能反應時間進步幅度 89
圖 5.4.1、運動與執行功能關係 107

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