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研究生: 李水碧
Lee Shuei-Pi
論文名稱: 十二週離心阻力訓練對中年女性心血管危險指標之影響
The Effects of 12-Week Eccentric Resistance Training on the Cardiovascular Risk Markers of Middle-Age Females
指導教授: 方進隆
Fang, Chin-Lung
學位類別: 博士
Doctor
系所名稱: 體育學系
Department of Physical Education
論文出版年: 2007
畢業學年度: 95
語文別: 中文
論文頁數: 241
中文關鍵詞: 離心阻力訓練C-反應蛋白同半胱胺酸心血管危險指標健康體適能
英文關鍵詞: Eccentric resistance training, C-reactive protein, Homocysteine, Risk markers of cardiovascular disease, Health-related physical fitness
論文種類: 學術論文
相關次數: 點閱:176下載:42
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  • 背景:心血管疾病與發炎反應有關聯性,阻力訓練是否有抗發炎效果而降低心血管疾病的風險,有待進ㄧ步探討。目的:探討12週離心阻力訓練對中年女性心血管疾病新危險指標的影響。方法:以38位中年婦女為研究對象,隨機分為運動訓練組19位 (48.5±7.0歲)與控制組19位 (49.1±7.1歲)。運動訓練組參與強調離心收縮的阻力訓練(每個動作的向心收縮期為2秒鐘,離心收縮期為6秒鐘),每週3天,每天60分鐘(10分鐘熱身運動,40分鐘阻力訓練,10分鐘緩和運動),持續12週,分三個階段循序漸進。訓練前後所有受試者各進行一次隔夜禁食抽血,分析血液中同半胱胺酸(tHCY)、C-反應蛋白(CRP)、總膽固醇(TC)、高密度脂蛋白-膽固醇 (HDL-C)、低密度脂蛋白-膽固醇 (LDL-C)、三酸甘油酯 (TG),並測量身體組成、肌耐力和心肺耐力;另結合CRP和LDL-C評估心血管整體風險等級(分為高、中、低風險),並結合CRP和TC:HDL-C比值評估心血管整體相對危險指數。所得結果以獨立樣本t-考驗、卡方考驗和多元迴歸分析,進行相關資料分析。結果:十二週離心阻力訓練後,體脂肪率、脂肪重、腰圍均有顯著降低(P<.05),淨體重顯著增加(P<.05),但體重和腰臀比均沒有顯著改變(P>.05);心肺耐力(六分鐘走路測驗)和肌耐力(修正式伏地挺身、腹部捲曲和靠牆蹲坐測驗)均有顯著進步(P<.05);CRP濃度顯著下降(1.35±1.70降為0.64±0.49 mg/L, P<.05),而且體重、BMI、心肺耐力和腰圍等變項是CRP下降的預測指標;tHcy些微升高(13.0±3.4 vs. 14.1±2.7μmol/L),但未達顯著差異水準(P>.05);心血管風險等級和相對危險指數均有顯著下降(P<.05)。結論:十二週的離心阻力訓練可以顯著改善中年婦女發炎指數、心血管疾病的風險和健康體適能。

    BACKGROUND:Cardiovascular disease is associated with inflammation, whether resistance training can lower inflammation and decrease the risk of heart disease deserved further investigation. PURPOSES:The purposes of this study were to investigate the effect of 12-week eccentric resistance training on cardiovascular risk factors, including C-reactive protein (CRP), total homocysteine (tHCY), cardiovascular relative risk, cardiovascular risk classification and the related physiological variables of middle-age females. METHODS:There were 38 middle-age female were recruited as the subjects for this study and randomly and equally divided into experimental group (48.5±7.0 years)and control group(49.1±7.1years). The subjects of experimental group were engaged in eccentric resistance training 3 days per week, 60 minutes ( including 10 minutes warming up, 40minutes resistance-exercise and 10 minutes cool down ) each session for 12 weeks; while the control subjects received no training. The resistance training emphasizes the eccentric portion with 6 seconds and 2 seconds for concentric contraction in one repetition. The variables of tHCY, CRP, total cholesterol, HDL-C, LDL-C, triglyceride, body composition, muscular endurance and physical fitness were measured or tested before and after 12 weeks of training. The cardiovascular global relative risk was assessed by the values of CRP with blood lipids (TC:HDL-C ratio). The cardiovascular global risk levels were evaluated by the values of CRP and LDL-C. the collected data were analyzed or compared by independent t test, Chi-square and multiple regression. RESULTS: After 12-week eccentric resistance training, the variables of body fat percent, fat mass and waist circumference have significantly decreased(P<.05), while the lean body weight was significantly increased (p<.05). However, the body weight and waist-hip ratio didn’t cause significant change (p>.05). The cardiovascular fitness(6-minute walk test) and muscular endurance(including modified push-up, abdominal hold, and wall sit) increased significantly (all p<.05) after training. The levels of CRP were significantly improved (1.35±1.17 vs. 0.64±0.49 mg/L, p<.05) after training, and the body weight, BMI, cardiovascular fitness, and waist circumference were the predictive variables for decreasing CRP. The levels of tHCY was slightly increased (13.0±3.4 vs. 14.1±2.7μmol/L) after 12 weeks of training, however it did not change significantly (p>.05). The variables of cardiovascular relative risk and cardiovascular risk classification also were significantly improved (both p<.05). CONCLUSION: The inflammation, cardiovascular global risk and health-related physical fitness were significantly improved after 12- week eccentric resistance training of middle-age females.

    中文摘要 ………………………………………………………………… Ⅰ 英文摘要 ………………………………………………………………… Ⅱ 謝 誌 …………………………………………………………………… Ⅲ 目 次 …………………………………………………………………… Ⅳ 表 次 …………………………………………………………………… Ⅳ 圖 次 …………………………………………………………………… X 第一章 緒 論…………………………………………………………… 1 第一節 問題背景…………………………………………………… 1 第二節 研究問題…………………………………………………… 3 第三節 研究目的…………………………………………………… 4 第四節 研究虛無假設……………………………………………… 4 第五節 研究範圍…………………………………………………… 5 第六節 研究限制 ………………………………………………… 5 第七節 名詞操作性定義…………………………………………… 5    一、離心阻力訓練計畫…………………………………………… 5    二、同半胱胺酸(Homocysteine)………………………………… 6    三、C-反應蛋白(C-reactive protein;簡稱CRP)…………… 6    四、心血管疾病的整體相對危險指數…………………………… 6    五、心血管疾病的整體風險等級………………………………… 7    六、體適能測驗…………………………………………………… 7 第八節 研究的重要性……………………………………………… 8 第二章 相關文獻探討 ………………………………………………… 9   第一節 心血管疾病的新危險指標………………………………… 9   第二節 同半胱胺酸(Homocysteine)與心血管疾病……………… 10    一、同半胱胺酸的病史…………………………………………… 11    二、同半胱胺酸的代謝途徑……………………………………… 12    三、同半胱胺酸引起心血管疾病的機轉………………………… 15    四、高同半胱胺酸血症的定義與分類…………………………… 18    五、高同半胱胺酸血症之成因…………………………………… 19     (一)遺傳基因 ………………………………………………… 22     (二)性 別 …………………………………………………… 23     (三)年 齡 …………………………………………………… 24     (四)吸 菸 …………………………………………………… 25     (五)喝 酒 …………………………………………………… 25     (六)咖 啡 …………………………………………………… 26     (七)生活型態 ………………………………………………… 27     (八)維生素 …………………………………………………… 27     (九)懷 孕 …………………………………………………… 27     (十)不同疾病的影響 ………………………………………… 28     (十一)藥 物 ………………………………………………… 28     (十二)高血壓 ………………………………………………… 29     (十三)腎臟功能 ……………………………………………… 30    六、血液中的同半胱胺酸 ……………………………………… 30    七、血液中同半胱胺酸的分析測定……………………………… 31 八、同半胱胺酸是動脈壁增厚的獨立危險因子………………… 32    九、同半胱胺酸是動脈粥狀硬化的獨立危險因子……………… 34    十、同半胱胺酸的前瞻性世代研究……………………………… 37    十一、維生素與心血管疾病的關聯性…………………………… 40    十二、降低同半胱胺酸的療法…………………………………… 42 第三節 C-反應蛋白(簡稱CRP)與心血管疾病 …………………… 44    一、CRP是急性發炎的指標……………………………………… 44    二、發炎反應與動脈粥狀硬化…………………………………… 46    三、CRP參與動脈粥狀硬化的形成……………………………… 48    四、CRP可評估健康者罹患心血管疾病的風險………………… 49    五、CRP比LDL-C是心血管疾病更好的預測指標……………… 51    六、CRP是心血管風險單一最強力預測指標…………………… 53    七、CRP與代謝症候群的關係…………………………………… 55    八、CRP與十年冠心病危險指數的關係………………………… 56    九、臨床上如何評估心血管疾病的風險………………………… 58   第四節 運動對同半胱胺酸(Homocysteine)的影響……………… 61    一、心肺適能與同半胱胺酸的關聯性…………………………… 62    二、單次急性運動對同半胱胺酸的影響………………………… 63    三、有氧運動訓練對同半胱胺酸的影響………………………… 66    四、減重對同半胱胺酸的影響…………………………………… 70    五、阻力訓練對同半胱胺酸的影響……………………………… 71   第五節 運動對CRP的影響………………………………………… 73    一、單次劇烈運動對CRP的影響………………………………… 73    二、身體活動或體適能與CRP的相關—橫斷面研究…………… 74    三、有氧運動訓練對CRP的影響—縱斷面研究………………… 82    四、動脈粥狀硬化患者身體活動與C-反應蛋白………………… 90    五、其他心血管疾病患者-運動的抗發炎效果………………… 93    六、阻力訓練與健康促進………………………………………… 93   第六節 本章結語…………………………………………………… 96 第三章 研究方法 ……………………………………………………… 98   第一節 受試對象…………………………………………………… 98   第二節 離心阻力訓練先前研究(pilot study)………………… 99   第三節 實驗設計…………………………………………………… 99   第四節 實驗時間…………………………………………………… 100   第五節 實驗分析與地點…………………………………………… 100   第六節 實驗步驟與儀器…………………………………………… 101    一、十二週離心阻力訓練課程…………………………………… 102    二、抽血及基本生理數值測量…………………………………… 104    三、身體組成測量………………………………………………… 107    四、肌耐力測驗…………………………………………………… 108    五、六分鐘走路測驗……………………………………………… 109   第七節 資料處理…………………………………………………… 110 第四章 結 果…………………………………………………………… 111   第一節 測驗結果之基本描述統計………………………………… 111    一、血液生化分析值之描述統計………………………………… 111    二、身體組成分析結果之描述統計……………………………… 112    三、體適能測驗結果之描述統計………………………………… 114    四、心血管整體風險等級歸類表………………………………… 114    五、心血管整體相對危險指數之描述統計……………………… 115   第二節 血液生化值之分析比較…………………………………… 115   第三節 身體組成之分析比較……………………………………… 116   第四節 體適能測驗之分析比較…………………………………… 116   第五節 心血管整體風險等級之類別分析………………………… 117   第六節 心血管整體相對危險指數之分析比較…………………… 117   第七節 CRP為效標的多元迴歸分析……………………………… 118   第八節 體重過重組和體重正常組訓練效果之比較……………… 118 第五章 討論與結論 …………………………………………………… 120   第一節 討論………………………………………………………… 120   一、十二週離心阻力訓練對同半胱胺酸的影響………………… 120    二、十二週離心阻力訓練對C-反應蛋白的影響……………… 127    三、十二週離心阻力訓練對心血管整體風險參數的影響……… 134    四、十二週離心阻力訓練對體適能的影響……………………… 138   第二節 結論與建議 ……………………………………………… 142    一、結 論………………………………………………………… 142    二、建 議………………………………………………………… 142  參考文獻 ……………………………………………………………… 144    一、中文部分……………………………………………………… 144    二、英文部分……………………………………………………… 145 附錄 附錄一 第一階段離心阻力訓練動作要領(徒手訓練) ………… 193 附錄二 第二階段離心阻力訓練動作要領(手持亞鈴訓練) …… 202 附錄三 第三階段離心阻力訓練動作要領(機械式訓練) ……… 211 附錄四 Immulite操作步驟……………………………………… 219 附錄五 自動生化分析儀CX-7的儀器原理及操作步驟………… 222 附錄六 同半胱胺酸的分析步驟 ………………………………… 226 附錄七 受試者須知 ……………………………………………… 227 附錄八 實驗同意書 ……………………………………………… 228 附錄九 運動安全問卷調查表 …………………………………… 229 附錄十 運動訓練組血液分析之原始資料 ……………………… 230 附錄十一 運動訓練組基本生理變項之原始資料 ………………… 231 附錄十二 控制組血液分析之原始資料 …………………………… 232 附錄十三 控制組基本生理變項之原始資料 ……………………… 233 附錄十四 運動訓練組運動能力測驗之原始資料 ………………… 234 附錄十五 控制組運動能力測驗之原始資料 ……………………… 235 附錄十六 運動訓練組心血管整體相對危險指數之原始資料 …… 236 附錄十七 控制組心血管整體相對危險指數之原始資料 ………… 238 附錄十八 運動訓練組心血管整體風險等級之原始資料 ………… 240 附錄十九 控制組心血管整體風險等級之原始資料 ……………… 241 表次 表1 冠狀動脈疾病的危險因子……………………………………… 10 表2 高同半胱胺酸血症的成因……………………………………… 21 表3 高同半胱胺酸血症與解剖部位動脈粥狀硬化………………… 33 表4 同半胱胺酸與心血管疾病-橫斷面研究與回朔性研究……… 35 表5 同半胱胺酸與心血管疾病-前瞻性世代研究………………… 38 表6 葉酸、維生素B6、維生素B12與心血管疾病………………… 41 表7 影響血中C-反應蛋白濃度的因素……………………………… 45 表8 單次急性運動對同半胱胺酸的影響…………………………… 64 表9 有氧運動訓練對同半胱胺酸的影響…………………………… 67 表10 阻力訓練對同半胱胺酸的影響………………………………… 71 表11 阻力訓練與肌酸增補對同半胱胺酸的影響…………………… 72 表12 老化與阻力訓練的適應………………………………………… 94 表13 運動訓練組與控制組訓練前的基本資料……………………… 99 表14 血液生化值訓練前後之描述統計……………………………… 111 表15 身體組成訓練前後之描述統計………………………………… 113 表16 體適能訓練前後之描述統計…………………………………… 114 表17 心血管整體風險等級訓練前後之歸類表……………………… 114 表18 心血管整體相對危險指數訓練前後之描述統計……………… 115 表19 血液生化值訓練前後之分析比較……………………………… 115 表20 身體組成訓練前後之分析比較………………………………… 116 表21 體適能訓練前後之分析比較…………………………………… 116 表22 運動訓練組心血管整體風險等級之卡方考驗………………… 117 表23 控制組心血管整體風險等級之卡方考驗……………………… 117 表24 心血管整體相對危險指數訓練前後之分析比較……………… 118 表25 CRP為效標的多元迴歸分析摘要表 …………………………… 118 表26 體重過重組和體重正常組訓練效果之分析比較……………… 119 圖次 圖1 同半胱胺酸的分子結構………………………………………… 13 圖2 同半胱胺酸的代謝途徑………………………………………… 14 圖3 同半胱胺酸的生化代謝及可能致病機轉……………………… 16 圖4 同光胱胺酸可產生過氧化氫…………………………………… 17 圖5 同半胱胺酸在血液中以四種型式循環存在…………………… 31 圖6 血液中LDL-C和CRP濃度與心血管疾病罹患率的關係……… 53 圖7 伯明罕計分表和CRP濃度與心血管疾病罹患率的關係……… 53 圖8 健康女性血液中C-反應蛋白、總膽固醇、脂蛋白和同半胱胺酸 的濃度與將來罹患心血管疾病的相對風險之直接比較…… 54 圖9 臨床上評估心血管整體疾病的相對危險指數之參考圖……… 60 圖10 臨床試驗運動降低CRP濃度的四種可能機轉………………… 92 圖11 研究流程………………………………………………………… 101 圖12 離心阻力訓練─訓練實況……………………………………… 103 圖13 抽血及基本生理數值之測量流程……………………………… 104 圖14 血液檢體採樣實況……………………………………………… 106 圖15 修正式伏地挺身測驗…………………………………………… 109 圖16 腹部捲曲測驗…………………………………………………… 109 圖17 靠牆蹲坐測驗…………………………………………………… 109 圖18 六分鐘走路測驗………………………………………………… 109 【第一階段離心阻力訓練的動作】 圖19 修正式伏地挺身………………………………………………… 194 圖20 傳統式伏地挺身………………………………………………… 195 圖21 板凳背後推撐…………………………………………………… 196 圖22 肱二頭肌捲舉…………………………………………………… 197 圖23 屈膝仰臥起坐…………………………………………………… 198 圖24 眼鏡蛇動作……………………………………………………… 199 圖25 拉門下蹲………………………………………………………… 200 圖26 前跨步下蹲……………………………………………………… 201 【第二階段離心阻力訓練的動作】 圖27 啞鈴站立單手捲舉……………………………………………… 203 圖28 啞鈴仰臥推舉…………………………………………………… 204 圖29 啞鈴站立雙手臂側平舉………………………………………… 205 圖30 啞鈴腹部捲曲…………………………………………………… 206 圖31 眼鏡蛇動作……………………………………………………… 207 圖32 啞鈴單腳站立舉踵……………………………………………… 207 圖33 啞鈴下蹲動作…………………………………………………… 208 圖34 啞鈴前跨步下蹲………………………………………………… 209 【第三階段離心阻力訓練的動作】 圖35 機械式坐姿肱二頭肌捲舉……………………………………… 211 圖36 機械式坐姿胸部推舉…………………………………………… 212 圖37 機械式雙手臂水平側拉………………………………………… 213 圖38 機械式坐姿腹部捲曲…………………………………………… 214 圖39 眼鏡蛇動作……………………………………………………… 215 圖40 機械式站立舉踵………………………………………………… 216 圖41 機械式斜坐腿部推舉…………………………………………… 217 圖42 機械式俯臥捲腿………………………………………………… 218 圖43 全自動生化分析儀……………………………………………… 222 圖44 裝填試劑………………………………………………………… 223

    一、中文部分
    方進隆(1997)。健康體能的理論與實務。台北:漢文書店。

    李水碧(譯)(2004)。體適能與全人健康的理論與實務。台北市:藝軒圖書  出版社。(Hoeger, W., W. K., & Hoeger, S., A., 2004)

    李建勳、湯仁彬、黃碧桃(2000)。C-反應蛋白在兒科臨床上的運用。臨
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