臺灣博碩士論文加值系統

研究背景與目的：吸菸會對身體健康產生危害。儘管許多文獻已提出長期吸菸會導致許多慢性疾病，像心血管系統疾病、肺部疾病、或癌症等。然而世界各國的吸菸人口仍相當普遍。在進展至疾病階段前，吸菸者可能已出現早期生理功能降低之徵象。本研究目的為比較吸菸者與從未吸菸者在運動能力、肺功能、骨骼肌功能，以及自主神經系統功能的差異，並檢驗吸菸是否為影響運動能力之獨立因子。研究方法：本研究為橫斷性觀察型研究，自臺北市社區招募自願受試者，評估方式包含身體組成分析、休息時心跳變異性、手握力、呼出一氧化碳測試、肺功能測試、呼吸肌功能、以及心肺運動功能測試。此外，尼古丁依賴程度量表(Fagerström Test for Nicotine Dependence)與七日身體活動量回憶問卷(Seven-Day Physical Activity Recall Questionnaire)則分別用於評估吸菸狀態與身體活動量。數據分析使用SPSS統計軟體第21.0版 (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.)，採用成對樣本t檢定(paired samples t-test)和魏克生符號檢定(Wilcoxon signed-rank test)分別比較兩組間之連續變項與類別變項之差異。皮爾森相關係數(Pearson’s correlation coefficient)及斯皮爾曼等級相關係數(Spearman’s rank-order correlation coefficient)用於分析所有測量參數之相關性，並使用逐步迴歸分析(stepwise regression analysis)檢驗吸菸與運動能力的獨立關聯性，並控制干擾因子(年齡、性別、身體活動量、與身體質量指數)。雙尾檢定之顯著程度定義為α< 0.05，檢力(power)為0.8。研究結果：本研究自臺北市社區邀請52位受試者(男性共42位(91.3%)，女性共10位(8.7%))，共46位受試者納入最終分析。受試者依據目前吸菸情形分成兩組：吸菸組(n=23)，非吸菸組(n=23)。所有受試者皆為年齡、性別、身體質量指數對應。吸菸組每日平均吸菸量為8.2 ± 6.3支/天，且平均菸齡為113.6 ± 91.4個月(約9.5年)。吸菸者的吐氣一氧化碳濃度以及家庭吸菸率顯著較非吸菸者高 (p < 0.05)。此外，吸菸組有顯著較低的最大攝氧量(maximal oxygen consumption)以及較低的第一秒用力吐氣容積與用力呼氣肺活量比值(p < 0.05)。吸菸相關參數包含吸菸狀態、菸齡、吸菸量、以及尼古丁依賴程度皆與最大攝氧量有顯著相關(p < 0.05)。此外，吸菸是運動耐力(β= -0.275, p = 0.005)與第一秒用力吐氣容積與用力呼氣肺活量比值(β= -0.473, p = 0.001)的獨立因子。然而，吸菸組與非吸菸組的骨骼肌質量、骨骼肌功能與自主神經系統功能並無顯著差異(p > 0.05)。結論：年輕吸菸者的吸菸量與運動耐力下降及肺功能降低有顯著相關性。本研究結果可提供吸菸對各項身體功能的早期影響，以強調早期監測與介入之重要性。

Background and purpose: Cigarette smoking has been reported to compromise health status. Studies suggested that long-term cigarette smoking would lead to many chronic diseases, such as cardiovascular diseases, pulmonary diseases, or cancer. However, there are still a great number of smokers all around the world. Before progressing into the disease stages, cigarette smokers might have presented some early signs of physiological function decline. The purposes of this study were: (1) to compare the differences in exercise capacity, pulmonary function, skeletal muscle function, and cardiac autonomic function between the smokers and never smokers, and (2) to test the hypothesis that cigarette smoking was an independent factor associated with exercise capacity. Methods: This was a cross-sectional observational study. This study recruited volunteer participants from the local communities in Taipei City. The assessments included: body composition analysis, resting heart rate variability, grip strength, exhaled carbon monoxide concentration, pulmonary function test, respiratory muscle performance, and cardiopulmonary exercise test. In addition, the Fagerström Test for Nicotine Dependence and Seven-Day Physical Activity Recall Questionnaire were used to evaluate the smoking status and physical activity, respectively. Statistical analyses were performed by the Statistical Package for the Social Sciences (SPSS) statistical package v.21.0 for Windows. (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Paired samples t-test and Wilcoxon signed-rank test were used to examine the differences in continuous and categorical data between two groups, respectively. Pearson’s correlation coefficients and Spearman’s rank-order correlation coefficients were adopted to examine the correlations between all measured parameters. Stepwise regression analysis was performed to examine the independent association between smoking status and exercise capacity after controlling for confounders (age, gender, physical activity, and body mass index). The statistical significance level was set at 0.05 (two-tailed test), and the power level was 0.8. Results: The present study recruited 52 subjects from local communities in Taipei City (42 were men (91.3%), 10 were women (8.7%)), and a total of 46 subjects were included for final analysis. The subjects were divided into two groups: the smoker group (n=23) and the never smoker group (n=23) based on the current smoking status. All subjects were age-, gender-, and body mass index-matched. The smoker group reported the amounts of smoking were 8.2 ± 6.3 cigarettes per day and the average smoking duration of 113.6 ± 91.4 months (around 9.5 years). Smokers had a higher exhaled carbon monoxide concentration and the rate of family smoking than the never smokers (p < 0.05). Furthermore, the smokers presented a significantly lower maximal oxygen consumption and lower forced expiratory volume in the forced expiratory volume in one second/forced vital capacity (FEV1/FVC ratio) (p < 0.05). Smoking parameters including smoking status, smoking duration, smoking amounts, and levels of nicotine dependence were all significantly correlated with maximal oxygen consumption (p < 0.05). In addition, smoking was an independent factor of exercise capacity (β= -0.275, p = 0.005) and FEV1/FVC ratio (β= -0.473, p = 0.001), respectively. There was no significant difference in skeletal muscle mass, skeletal muscle function, and cardiac autonomic function between the two groups (p > 0.05). Conclusion: Cigarette smoking amounts were significantly associated with decreased exercise capacity and pulmonary function in young cigarette smokers. The present results could provide the early effects of cigarette smoking on physical function, and highlight the importance of early detection and intervention.

Contents
口試委員審定書 i
致謝 ii
中文摘要 iii
Abstract v
Contents viii
List of Tables x
List of Figures xi
Chapter 1. Introduction 1
1.1. Research background 1
1.2. Purposes 3
1.3. Hypotheses 3
1.4. Operational definitions of variables 4
1.5. Importance of the study 7
Chapter 2. Literature Review 9
2.1. Overview of cigarette smoking 9
2.2. Cigarette smoking and exercise capacity 12
2.3. Cigarette smoking and heart rate variability 16
2.4. Cigarette smoking and skeletal muscle function 18
Chapter 3. Research Design and Methods 23
3.1. Study design 23
3.2. Participants 23
3.3. Procedures 24
3.4. Measurements 25
3.5. Statistical analyses 34
Chapter 4. Results 36
4.1. Demographic data 36
4.2. Smoking status 37
4.3. Body composition, skeletal muscle function, and cardiac autonomic function 38
4.4. Pulmonary function test 38
4.5. Exercise capacity 39
4.6. Correlations between cigarette smoking and exercise capacity, pulmonary function, and skeletal muscle function 40
4.7. Associations between cigarette smoking and exercise capacity and pulmonary function 41
Chapter 5. Discussion 42
5.1. The profile of cigarette smoking 42
5.2. Cigarette smoking and decreased exercise capacity 45
5.3. Cigarette smoking and decreased pulmonary function 48
5.4. Cigarette smoking and skeletal muscle function 50
5.5. Limitations 52
Chapter 6. Conclusion 53
References 54
附錄一、倫理委員會審查文件 85
附錄二、受試者基本資料表 86
附錄三、尼古丁依賴程度量表 88
附錄四、七日活動回憶問卷 90
List of Tables
Table 1. Exercise capacity in smokers and non-smokers 68
Table 2. Skeletal muscle function in smokers and non-smokers 71
Table 3. Demographic data of subjects 73
Table 4. Smoking status of subjects 75
Table 5. Comparison of body composition, skeletal muscle function between smokers and never smokers 77
Table 6. Comparison of cardiac autonomic function between smokers and never smokers 78
Table 7. Comparison of pulmonary function between smokers and never smokers 79
Table 8. Comparison of exercise capacity between smokers and never smokers 80
Table 9. Correlations of exercise capacity, pulmonary function, and skeletal muscle function 81
Table 10. Regression outcome of exercise capacity and pulmonary function 83
List of Figures
Figure 1. Flow chart 84

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