臺灣博碩士論文加值系統

背景
台灣及全世界逐漸邁入高齡社會，年紀增長引起的疾病越來越受到重視。隨著年紀增長及老化，身體活力下降及運動量減少，使得肌肉流失及萎縮，此惡性循環常發生在高齡族群中(張，2014)，在各個社區中的老人，得到衰弱的盛行率變化範圍大，約4 % ~ 59 %不等，而整體而言大約落在9.9%~13.6%之間，男性、女性的盛行率而言，則是男性5.2%、女性9.6%，罹病率則皆隨著年齡增長而增加(Collard, Boter, Schoevers, & Oude Voshaar., 2012)。另外，2015年國家衛生研究院利用HALST資料分析發現65歲以上老人的衰弱症盛行率為5.4%，而41.5%的老人屬於衰弱前期，這群社區老人普遍患有的共病症包括高血壓、糖尿病、心血管疾病等，且衰弱症老人的共病症盛行率較正常老人與衰弱前期老人高(國衛院，2015)；國外文獻中亦指出若在社區的老年人中，在其發生衰弱前，做初級的預防相較老年人發生衰弱後來的治療，相對的效益較高(Metzelthin et al., 2013)。
目的
探索經由實證文獻建構的彈力帶運動訓練方案是否能改善衰弱前期長者的生理功能、體適能、平衡及自覺健康與活動能力狀態。並建構一套衰弱前期長者，能持續常規操作的運動訓練方式，進而維持其身體功能的運動訓練方法。
方法
本研究採雙組前後測的介入類實驗性研究設計，樣本以立意取樣方式招募研究對象，資料收集部分為單盲設計。實驗組運用彈力帶介入執行抗阻力運動訓練，每次50分鐘，每週3次，共計12週，控制組以衛教方式說明運動的重要性及實行注意事項，共進行四次的成效指標測量。透過彈力帶運動訓練探討同一群受測者之功能性體適能、跌倒平衡能力、握力、步行速度、老人憂鬱狀態、身體功能、體重、BMI、身體肌肉量、認知功能、營養狀態與自覺健康及活動能力是否有顯著差異。
結果
在十二週的彈力帶運動訓練介入後，生理指標方面，體重、BMI、肌肉量這三個項目，皆在第十二週的介入後，有統計顯著的差異(p= 0.042；p= 0.044；p= 0.001 )，但在第十六週有下降的情形，表示在沒有持續介入的情況下，體重、BMI、肌肉量這三個項目是會容易有退步的情形產生；自覺狀態部分，在自覺健康狀態第十二、十六週達到統計上的顯著(p= 0.030；p= 0.020 )、自覺活動能力在第十六週達到統計上的顯著(p= 0.013)；MMSE的部分，在第十二、十六週達到統計上的顯著(p= 0.022；p< 0.001)；銀髮族體適能相關項目包含上肢與下肢部分各個項目於第十二週與第十六週測量皆達統計上的顯著差異；此外，跌倒評估總分在第八、十二、十六週(p= 0.014；p< 0.001；p< 0.001)，實驗組與對照組比較後，皆有達到統計上的顯著。
結論/實務應用
本研究結果證實，這一套彈力帶運動訓練設計，對於衰弱前期的長者生理、心理及體適能狀態，皆有極大的幫助。對於護理專業未來於社區推動健康促進，有極大的幫助，本研究所設計的彈力帶運動課程，可供未來社區推動長者們的活躍老化，促進其下肢的肌力，進而減少高齡長者們跌倒的機率，有極大的助益。因此，未來在社區居家安居的長者可以透過簡易的運動訓練維持健康體適能，減緩老化造成的生理、心理及社會層面的負面影響。
關鍵詞：衰弱前期、彈力帶、運動訓練、體適能、平衡、長者

Background
With the world, including Taiwan, shifting ever closer to having an aged population, diseases associated with ageing are drawing increasing attention. A person who is growing older would usually cut back on physical activities and exercise, which would lead to muscle loss and atrophy. This is vicious cycle is often observed in the elderly population (Chang, 2014). The prevalence of frailty among elderly people differs greatly across various communities (4% to 59%) and generally falls within the 9.9% to 13.6% range. The prevalence of frailty in males and females is 5.2% and 9.6%, respectively; and as for morbidity rates, they rise with age (Collard, Boter, Schoevers, & Oude Voshaar., 2012). In 2015, the National Health Research Institutes (NHRI) carried out a HALST data analysis which revealed: that the prevalence of frailty among the elderly population aged 65 and above was 5.4%, and that 41.5% of the elderly population were in the pre-frail stage; these people generally suffered from comorbidities such as hypertension, diabetes, and cardiovascular disease, and the prevalence rates of comorbidities among the frail elderly were higher compared to those for normal and pre-frail elderly people (NHRI, 2015). Overseas studies also indicated that, for the elderly in communities, it was more effective to carry out early preventive measures as compared to treatments after the onset of frailty (Metzelthin et al., 2013).
Objective
The study aimed to investigate whether an elastic band exercise program developed from empirical research can improve the physiological functions, physical fitness, fall risk, balance, and self-awareness of health and activity status of pre-frail elderly people. An exercise program that can be implemented on a regular basis was then developed, so as to help these elderly people to maintain their physical functions.
Method
In this study, an interventional and experimental research design with two-group pre-testing and post-testing was utilized. The study's participants were recruited using purposive sampling, and data collection was carried out via a single-blind approach. The participants in the experimental group underwent elastic band resistance training. Three 50-minute training sessions were conducted weekly over a 12-week period. The participants in the control group were subjected to health education that emphasized the importance of exercise and the precautions to take note of, and four rounds of measurements were taken with respect to assess the performance indicators for health education. After the elastic band resistance training was completed, the functional fitness, balance ability, grip strength, walking speed, level of depression, physical functions, weight, body mass index (BMI), muscle mass, cognitive function, nutritional status, and self-awareness of health and activity status of the participants were assessed to determine if there were any significant differences between the groups.
Results
After the intervention that comprised 12 weeks of elastic band resistance training was completed, significant differences were observed with respect to three physiological indicators, namely weight, BMI, and muscle mass (p= 0.042; p= 0.044; p= 0.001). However, a decline was observed in the 16th week, indicating that the absence of continued intervention can easily lead to a decline in these three indicators. With regard to self-awareness, significant differences were observed in the 12th and 16th weeks with respect to the self-awareness of one's health status (p= 0.030; p= 0.020); a significant difference was observed in the 16th week with respect to the self-awareness of one's ability to perform activities (p= 0.013). Concerning the Mini–Mental State Examination (MMSE), significant differences were observed in the 12th and 16th weeks (p= 0.022; p< 0.001). As for the physical fitness-related items, which include items covering the upper and lower limbs, significant differences were observed in the 12th and 16th weeks. Furthermore, significant differences between the experimental and control groups were observed with respect to overall fall risk assessment scores in the 8th, 12th, and 16th weeks (p= 0.014; p< 0.001; p< 0.001).
Conclusion/Practical Application
The results confirmed that the elastic band resistance training helped to improve the physiological, psychological, and physical fitness statuses of pre-frail elderly people. These findings will contribute immensely to community health promotion as carried out in the future by nursing professionals. The elastic band resistance training designed in this study can help elderly people in the community to engage in active aging, strengthen their lower limb muscles, and thus reduce their fall risk. In the future, elderly people in the community can perform these simple exercises to maintain a healthy level of fitness and reduce the negative physical, psychological and social effects brought about by aging.


Keywords: pre-frailty, elastic band, exercise training, physical fitness, balance, elderly

中文摘要-------------------------------------------------------------------------------------- i
英文摘要-------------------------------------------------------------------------------------- iii
目次------------------------------------------------------------------------------------------ vi
表次------------------------------------------------------------------------------------------ viii
圖次------------------------------------------------------------------------------------------ ix
第一章 緒論-------------------------------------------------------------------------- 1
第一節 研究背景與動--------------------------------------------------------------- 1
第二節 研究目的------------------------------------------------------------------- 3
第三節 研究問題------------------------------------------------------------------- 4
第四節 研究假設------------------------------------------------------------------- 5
第五節 名詞定義------------------------------------------------------------------- 6
第二章 文獻探討----------------------------------------------------------------------- 8
第一節 衰弱症簡介----------------------------------------------------------------- 8
第二節 衰弱造成肌力流失的機轉與處置-------------------------------------------------- 10
第三節 彈力帶肌力訓練-------------------------------------------------------------- 12
第三章 研究方法----------------------------------------------------------------------- 16
第一節 研究對象------------------------------------------------------------------- 16
第二節 研究設計------------------------------------------------------------------- 17
第三節 研究工具------------------------------------------------------------------- 18
第四節 研究步驟------------------------------------------------------------------- 34
第五節 資料處理與統計分析----------------------------------------------------------- 36
第六節 倫理考量------------------------------------------------------------------- 38
第四章 研究結果----------------------------------------------------------------------- 39
第一節 研究樣本群基本屬性描述性資料及介入前主要變項資料描述- 39
第二節 介入後第八、十二、十六週研究對象主要變項資料描述------- 49
第三節 介入前後兩組主要成效變項比較分析------------------------------- 58
第五章 討論與結論---------------------------------------------------------------------- 75
第一節 介入措施對改善衰弱前期長者其生理指標、慣用手握力、直線十五英呎步行速度、功能性體適能及跌倒風險評估(BBS)的成效---- 75
第二節 介入措施對改善衰弱前期長者憂鬱、營養狀態、認知功能、自覺健康狀態與自覺活動能力的成效------------------------- 77
第三節 研究限制與建議---------------------------------------------------------- 79
第四節 護理專業之貢獻---------------------------------------------------------- 80
第六章 參考文獻------------------------------------------------------------------------- 81
中文部分------------------------------------------------------------------------------- 81
英文部分------------------------------------------------------------------------------- 83
附錄------------------------------------------------------------------------------------------- 87
附件一---------------------------------------------------------------------------------- 87
附件二---------------------------------------------------------------------------------- 91
附件三---------------------------------------------------------------------------------- 96
附件四---------------------------------------------------------------------------------- 99
附件五--------------------------------------------------------------------------------- 100
附件六--------------------------------------------------------------------------------- 102
附件七--------------------------------------------------------------------------------- 103
附件八--------------------------------------------------------------------------------- 104
附件九--------------------------------------------------------------------------------- 105
附件十--------------------------------------------------------------------------------- 106
附件十一------------------------------------------------------------------------------- 107

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