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研究生: 何信弘
Ho, Hsin-Hung
論文名稱: 驗證社區高齡者功能性體適能快速評估與多元性運動介入效益之研究
Verify the effect of rapid functional fitness test and the multi-component exercise training for community-dwelling older adults
指導教授: 張少熙
Chang, Shao-Hsi
學位類別: 博士
Doctor
系所名稱: 體育學系
Department of Physical Education
論文出版年: 2016
畢業學年度: 105
語文別: 中文
論文頁數: 136
中文關鍵詞: 肌少症握力單腳站立多元性運動高齡者
英文關鍵詞: sarcopenia, hand grip strength, one-leg standing test, multi-component exercise, older adult
DOI URL: https://doi.org/10.6345/NTNU202204617
論文種類: 學術論文
相關次數: 點閱:381下載:114
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  • 社區高齡運動是經濟與有效的方案,廣為各國採行。隨著運動需求日增,運動介入朝向分眾化、專業化才能提升資源分配的效益。我國高齡者參與運動比例雖高、時間也足夠,但仍有社區部分高齡者受肌少症的侵襲增加失能、跌倒風險,其背後原因亦值得探究,過往研究指出運動方案辦理上缺乏評估策略,難以針對需求提供適當運動介入,混合式的編班方式,參與運動的效益也難以釐清,皆會造成健康促進資源的浪擲。為提出具體論證並解決此困境,本研究目的有二,首先欲瞭解快速評估系統與功能性體適能的相關性與預測效力,其次要驗證不同肌少症風險者參與多元運動介入方案的效益跟限制,為達研究目的,本研究分別採用調查研究法及準實驗法。調查研究法的部分,總計調查臺北市與臺南市共145位高齡者之功能性體適能、握力、單腳站立之表現,參與者平均年齡71.35歲;其次,以準實驗設計確認不同肌少症風險高齡者,在共同參與依ACSM建議編制的多元性運動訓練 (伸展、阻力、有氧及平衡運動) 介入後,藉由第0週、第13週實施功能性體適能測驗,了解其效益與差異,共有60位高齡者完成介入與測試,平均年齡74.62歲,於考驗水準α<.05下,分別進行獨立樣本t檢定、卡方檢定、相關分析、多元迴歸分析及二因子重複量數變異數分析等。調查研究部分,確認快速評估系統與功能性體適能在上肢肌力、下肢肌力、動態平衡等存有中等以上顯著相關性,並存在線性關係且有中等以上的預測效益;準實驗設計之結果發現多元性運動介入效益依據肌少症風險之不同存有差異,高風險者所得的運動效益顯著較低。建議未來高齡者運動介入應採取能力分組,可提高促進效益、降低風險並充分針對需求設計專業課程,同時降低主辦單位的評估成本。

    Exercise training, an economic and effective strategy to boost the health of community-dwelling older adults, has been adopted in many countries for the past decades. Research shows that a high percentage of the aged population in Taiwan do spend quite an amount of time on daily activities or health-related programs; however, there is widespread lack of intensity. This lack of intensity leads to them suffering from sarcopenia and increases their risk of falling down or becoming disabled. Unfortunately, the aged are not offered proper exercise training, based on their functional fitness or performance tests. They are mixed in the same programs despite their fitness differences, which has greatly reduced the effects of exercise training and has wasted lots of public resources. This study aims to verify the efficiency of rapid functional fitness tests to help health-promoting workers on the primary level to assess more accurately and conveniently the fitness of the older adults. In addition, this study focuses on the effectiveness of multi-component exercise training for people at different risk levels of sarcopenia. To this end, researcher used survey research and quasi-experiment method. The subjects of the first project were recruited from the health-promoting programs held in Taipei and Tainan, sponsored by the Ministry of Science and Technology in 2015 and Taipei city government. In it, 145 participants, averagely 71.35 years of age, completed Senior Functional Fitness Test (SFT), Handgrip Test, and One-leg Standing Test with their eyes open. Then in a quasi-experiment, another 60 older adult were recruited from the mentioned program, averagely 74.62 years of age and at different risk levels of sarcopenia, were selected and given multi-exercise training (aerobic exercise, resistance exercise, flexibility exercise, and balance training) for 12 weeks. By checking their performance differences at the beginning and at the end of the program, the efficiency of the tests and the effectiveness of the training are revealed. Based on the findings, it is strongly suggested that rapid multi-functional tests should be given to the aged before the intervention of exercise training, and that they should be put into different groups based on their fitness. By doing this, the program can be more effective, run lower
    risk, cater to personal needs of the aged, and save the assessment cost.

    目次 論文通過簽名表……………………………………………………………… i 學位論文授權書……………………………………………………………… ii 中文摘要……………………………………………………………………… iii 英文摘要……………………………………………………………………… iv 謝誌…………………………………………………………………………… vi 目次…………………………………………………………………………… vii 表次…………………………………………………………………………… x 圖次…………………………………………………………………………… ix 第壹章 緒論…………………………………………………………………………… 1 第一節 背景與動機…………………………………………………………………………… 1 第二節 研究目的…………………………………………………………………………… 8 第三節 研究問題…………………………………………………………………………… 9 第四節 研究範圍與限制…………………………………………………………………………… 10 第五節 研究重要性…………………………………………………………………………… 11 第六節 名詞操作性定義…………………………………………………………………………… 12 第貳章 文獻探討…………………………………………………………………………… 14 第一節 成功老化與高齡者健康促進…………………………………………………………………………… 14 第二節 高齡者功能性表現與肌少症的關係…………………………………………………………………………… 18 第三節 社區健康評估系統的重要性…………………………………………………………………………… 28 第四節 高齡者社區運動支持系統…………………………………………………………………………… 37 第五節 本章總結…………………………………………………………………………… 50 第參章 研究方法…………………………………………………………………………… 51 第一節 研究架構…………………………………………………………………………… 51 第二節 研究流程…………………………………………………………………………… 53 第三節 研究參與者…………………………………………………………………………… 54 第四節 研究工具…………………………………………………………………………… 56 第五節 實驗設計…………………………………………………………………………… 61 第六節 實施步驟與程序…………………………………………………………………………… 62 第七節 資料分析與處理…………………………………………………………………………… 64 第肆章 結果與討論…………………………………………………………………………… 65 第一節 快速評估系統與功能性體適能評估系統之關係…………………………………………………………………………… 65 第二節 快速評估系統對功能性體適能之預測效力…………………………………………………………………………… 73 第三節 肌少症風險、運動介入與功能性體適能表現之關係…………………………………………………………………………… 80 第四節 本章總結…………………………………………………………………………… 94 第伍章 結論與建議…………………………………………………………………………… 99 第一節 結論…………………………………………………………………………… 99 第二節 建議…………………………………………………………………………… 101 參考文獻…………………………………………………………………………………103 附錄一:研究倫理審查核可證明書………………………………………………………131 附錄二:研究參與者知情同意書………………………………………………………132 附錄三:身體活動適應能力問卷………………………………………………………135 附錄四:高齡者功能性體適能檢測表格…………………………………………………136 表 次 表2-1 2003~2012年醫療保健支出平均每人每年醫療支出比較表…………………………………………………………………………… 17 表2-2 高齡者肌少症風險與各項功能性表現研究一覽表…………………………………………………………………………… 24 表2-3 世界各國際組織有關肌少症共識會議結論整理…………………………………………………………………………… 26 表2-4 國內高齡者研究體適能表現評估工具與項目一覽表…………………………………………………………………………… 39 表2-5 ACSM高齡者運動準則建議一覽表…………………………………………………………………………… 43 表2-6 生態學模式介入身體活動策略一覽表…………………………………………………………………………… 46 表2-7 國內外社區高齡者多元或整合運動相關研究一覽表…………………………………………………………………………… 48 表3-1 功能性體適能測驗再測信度與效度一覽表…………………………………………………………………………… 56 表3-2 功能性體適能測量方法一覽表…………………………………………………………………………… 57 表3-3 握力實施步驟與參考標準…………………………………………………………………………… 59 表3-4 睜眼單足站立實施步驟…………………………………………………………………………… 60 表3-5 平衡能力常模參照一覽表…………………………………………………………………………… 60 表3-6 實驗設計表…………………………………………………………………………… 61 表3-7 多元性運動訓練課程一覽表…………………………………………………………………………… 63 表4-1 研究對象基本生理條件同質性檢定一覽表…………………………………………………………………………… 66 表4-2 全體研究參與者快速評估與功能性體適能之相關摘要表 (N=145)…………………………………………………………………………… 67 表4-3 全體研究參與者快速評估與功能性體適能之相關摘要表 (N=145)…………………………………………………………………………… 68 表4-4 低肌少症風險者快速評估與功能性體適能之相關摘要表 (N=94) ……………………………………………………………………………69 表4-5 低肌少症風險者快速評估與功能性體適能之相關摘要表 (N=94)…………………………………………………………………………… 70 表4-6 高肌少症風險者快速評估與功能性體適能之相關摘要表 (N=51)…………………………………………………………………………… 71 表4-7 高肌少症風險者快速評估與功能性體適能之相關摘要表 (N=51)…………………………………………………………………………… 72 表4-8 全體研究參與者快速評估與功能性體適能之迴歸摘要表 (N=145)…………………………………………………………………………… 75 表4-9 低肌少症風險研究參與者快速評估與功能性體適能之迴歸摘要表 (N=94)…………………………………………………………………………… 77 表4-10 高肌少症風險研究參與者快速評估與功能性體適能之迴歸摘要表 (N=51)…………………………………………………………………………… 79 表4-11 不同肌少症參與者功能性體適能測驗前測表現摘要表…………………………………………………………………………… 81 表4-12 坐姿起立測驗摘要表…………………………………………………………………………… 83 表4-13 手臂彎舉測驗摘要表…………………………………………………………………………… 85 表4-14 2分鐘踏步測驗測驗摘要表…………………………………………………………………………… 87 表4-15 坐姿體前彎測驗測驗摘要表…………………………………………………………………………… 89 表4-16 抓背測驗摘要表…………………………………………………………………………… 91 表4-17 8英尺起身繞行測驗摘要表…………………………………………………………………………… 93 表4-18 各種肌少症風險高齡者各項功能性體適能與快速評估項目相關性一覽表…………………………………………………………………………… 94 表4-19 各種肌少症風險高齡者各項功能性體適能與快速評估項目預測性一覽表…………………………………………………………………………… 94   圖 次 圖2-1 成功老化的定性模型 (Qualitative model of successful aging)…………………………………………………………………………… 15 圖2-2 生涯中正常與異常的肌肉量、肌力減少模型…………………………………………………………………………… 20 圖2-3 肌少症與失能、病理結果關係圖…………………………………………………………………………… 23 圖2-4 膝伸展肌力檢測儀器…………………………………………………………………………… 28 圖2-5 高齡者田野測驗與運用範圍關係圖…………………………………………………………………………… 33 圖2-6 依照性別、國家別區分,且經調整年齡、身高後的握力表現分布圖…………………………………………………………………………… 34 圖2-7 亞洲肌少症工作小組建議之高齡者肌少症診斷流程…………………………………………………………………………… 40 圖3-1 建構快速評估系統研究架構圖…………………………………………………………………………… 51 圖3-2 驗證運動支持系統研究架構圖…………………………………………………………………………… 52 圖3-3 相關與預測研究流程圖…………………………………………………………………………… 53 圖3-4 多元運動介入效益與差異研究流程圖…………………………………………………………………………… 53 圖3-5 功能性體適能測驗流程圖…………………………………………………………………………… 58 圖4-1 不同組別與時間測驗在坐姿起立比較分析圖…………………………………………………………………………… 83 圖4-2 不同組別與時間測驗在手臂彎舉比較分析圖…………………………………………………………………………… 85 圖4-3 不同組別與時間測驗在2分鐘踏步測驗比較分析圖…………………………………………………………………………… 87 圖4-4 不同組別與時間測驗在坐姿體前彎測驗比較分析圖…………………………………………………………………………… 89 圖4-5 不同組別與時間測驗在抓背測驗比較分析圖…………………………………………………………………………… 91 圖4-6 不同組別與時間測驗在8英呎起身繞行比較分析圖…………………………………………………………………………… 93 圖4-7 社區高齡者功能體適能快速評估系統運用評估分析圖…………………………………………………………………………… 98

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