臺灣博碩士論文加值系統

有關計畫性的有氧運動訓練對第二型糖尿病患胰島素抗阻性與心理社會的成效之研究仍少見。因此本研究目的將探討十二週耐力運動訓練對第二型糖尿病患者胰島素敏感性、血糖控制、血清脂質、身體組成、心肺耐力與血壓、及生活品質、憂鬱狀態的成效。本研究以類實驗設計，採立意取樣方式，收集13位符合條件之第二型糖尿病患者，所有患者進行為期十二週的中強度有氧運動訓練(60%的最大攝氧量、每週三天、每次30分鐘)。每運動訓練四週後，進行口服葡萄糖耐受試驗，抽測胰島素與血糖濃度，此外，收集所有其他生理指標及心理層面之主觀資料。研究工具包括基本屬性量表、生活品質量表(SF-36)與憂鬱狀態評估量表(BDI)。描述性統計以次數分佈、平均數、標準誤及百分比描述研究對象之基本人口學特質、運動前後各項指標資料，以廣義估計方程式(GEE)分析運動訓練前後的差異，並同時探討隨著運動訓練時間的增加，對各項指標的變化為何。
研究結果發現在控制可能的干擾因子後，第二型糖尿病患者接受十二
週運動訓練後生理指標多與運動前呈顯著的改善，尤其OGTT血糖之曲線下面積(p< .0001)、OGTT之各時間點的血糖濃度、三酸甘油脂等都顯著性的改善(p< .0001)。空腹血糖、糖化血色素、體重、身體質量指數、腰臀比、心跳率、收縮壓與舒張壓亦皆明顯降低(p< .0001)。此外，運動訓練對心肺耐力指標-- VO2max也顯著地提升。唯空腹胰島素濃度、OGTT各時間點胰島素(除120分鐘之胰島素濃度)、OGTT胰島素之曲線下面積、總膽固醇、低密度脂蛋白、和高密度脂蛋白等並無顯著差異。而隨著運動訓練時間的增加，除胰島素之曲線下面積、OGTT各時間點之胰島素濃度、OGTT之30分鐘的血糖濃度、總膽固醇、低密度脂蛋白和高密度脂蛋白外，皆有逐漸改善的趨勢。另外，本研究中也發現透過運動訓練可以有效改善生活品質與憂鬱狀態。在生活品質量表的八項次構面與兩個次主成分(PCS & MCS)中，除身體疼痛(BP)之次構面與身體健康成份(PCS)之得分的改善未達顯著意義外，其他如身體功能狀態(PF)、因身體問題導致角色限制(RP)、身體疼痛(BP)、整體健康狀況(GH)、活力狀態(VT)、社交功能(SF)、因情緒問題導致角色限制(RE)、與心理健康(MH)等七個次構面與心理健康成份(MCS)皆呈顯著性的改善(p< .05)，並且隨著運動訓練時間的增加，而有逐漸提升的趨勢(p< .05)。
本研究結論為運動訓練確實可以有效改善第二型糖尿病患者的胰島素敏感性、血糖控制、血清脂質、身體組成、與心肺耐力和血壓。此外，透過規律的運動訓練甚至可以提升患者的生活品質，及降低憂鬱情形。希望藉此研究結果可讓臨床上更瞭解衛教第二型糖尿病患從事適當運動訓練的重要性，並提供患者一正確、安全的運動處方，以改善病患的身體狀況、提升生活品質和降低憂鬱狀態。

Little is known about the relation of planed exercise training to insulin sensitivity and psychosocial effects in type 2 diabetes. The purpose of this study was to explore the effects of 12-week endurance training on insulin sensitivity, metabolic control, serum lipids, body composition, cardiorespiratory fitness, blood pressure in addition, the improvement of quality of life and depression among patients with type 2 diabetes.
The quesi-experimental design and purposive sampling were fulfilled in this study. The samples consisted of 13 eligible cases with type 2 diabetes. Each subject underwent 12-week exercise program (1hr a day, 3days a week, at 60% maximum oxygen uptake). Every 4 weeks training, insulin, glucose level were measured after an overnight fast and 75-g oral glucose challenge(OGTT). Besides, other physical parameters and psychosocial effects were also performed. The major instruments in this study include demographic scale, Medical Outcomes Study (MOS) Short-Form-36 (SF-36) for quality of life, and Beck Depression Inventory (BDI) for depression. Descriptive analysis were performed first to understand the frequencies and distributions of the characteristics of the samples and data of all pre-training and post-training parameters; Generalized Estimating Equations (GEEs) were used to examined the differences between pre-training and post-training among patients, further, GEEs were simultaneously used to determinate the time effects of exercise training on all parameters.
After 12-week exercise training program, the results indicate that almost either the physiological parameters, or the psychosocial aspects were significantly improved. Especially the OGTT glucose area under the curve(p< .0001) and OGTT glucose level(0’, 60’, 90’, 120’), triglyceride (p< .05) were lower after adjusting possible confounding factors. Furthermore, fasting glucose, HgbA1c, body weight, BMI, waist-to-hip ratio, HRrest, SBP and DBP were decreased(p< .0001) significantly, too. Physical training also resulted in a significant improvement in VO2max. However, fasting insulin, OGTT insulin OGTT insulin area under the curve, total cholesterol, LDL, and HDL didn’t change except the 120’ OGTT insulin. And besides the OGTT insulin AUC, OGTT insulin, TC, LDL, and HDL, the more time of exercise training they received, the more they improved. Another significant improvement on quality of life and depression were investigated in this study. Among eight subscales and two main components (PCS & MCS) of SF-36, physical function, role-physical, general health, vitality, social function, role-emotional, and mental health, mental component scale(MCS) were elevated(p< .05) except bodily pain and physical component scale(PCS). And the more time of exercise training they received, the more their QOL and depression improved(p< .05).
It is concluded that exercise-induced improvement in insulin sensitivity, metabolic control, serum lipids, body composition, cardiorespiratory fitness and blood pressure in type 2 diabetes. Even the physical training may result in a better quality of life and lower depression. We would like to propose our clinics the importance to educate patients with type 2 diabetes how to do the adequate exercise training, and providing precise exercise prescriptions for these patients to improve their physical status, quality of life, and depression.

正文目錄
頁碼
第一章 緒論…………………………………………………………………1
第一節 問題重要性…………………………………………………….1
第二節 研究動機……………………………………………………….3
第三節 研究目的……………………………………………………….4
第二章 文獻查證……………………………………………………………5
第一節 第二型糖尿病的病生理變化…………………………………5
第二節 糖尿病患者的生活品質與憂鬱情形.……………………….7
第三節 運動處方的相關概念…………………………………………13
第四節 運動對第二型糖尿病患之身心效果及其相關研究…………19
第三章 研究架構…………………………………………………………..32
第一節 研究設計……………………………………………………..32
第二節 概念架構……………………………………………………..33
第三節 研究問題與假設……………………………………………..35
第四節 名詞解釋……………………………………………………..36
第四章 研究方法…………………………………………………………..40
第一節 研究對象……………………………………………………..40
第二節 運動測試與運動訓練計畫…………………………………..41
第三節 研究工具……………………………………………………..43
第四節 研究工具的信效度…………………………………………..45
第五節 研究步驟……………………………………………………..48
第六節 資料處理與分析……………………………………………..51
第五章 研究結果…………………………………………………………..53
第一節 個案基本人口學資料………………………………………..53
第二節 個案運動訓練前後的生理指標狀況………………………..55
第三節 個案運動訓練前後的生活品質與憂鬱狀態………………..70
第四節 運動訓練對患者生理指標之成效…………………………..75
第五節 運動訓練對患者生活品質之成效…………………………..92
第六節 運動訓練對患者憂鬱狀態之成效…………………………..99
第六章 討論與分析………………………………………………………..102
第一節 病患之特性…………………………………………………..102
第二節 運動訓練對病患生理指標的影響…………………………..103
第三節 運動訓練對病患生活品質的影響…………………………..110
第四節 運動訓練對患者憂鬱狀態的影響…………………………..113
第七章 結論與建議………………………………………………………..116
第一節 結論…………………………………………………………..116
第二節 研究限制與建議……………………………………………..119
第三節 研究應用……………………………………………………..122
參考文獻…………………………………………………………………...124
中文部份…………………………………………………………….....124
英文部份…………………………………………………………….....127

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