簡易檢索 / 詳目顯示

研究生: 周宛嬋
Wan-Chan Chou
論文名稱: 老年男性不同踝臂指數與下肢肌肉氧合能力及心肺適能之研究
The Study of Leg Muscle Oxygenation and Cardiorespiratory Fitness of Elderly Males with Different Ankle-Brachial Index
指導教授: 方進隆
Fang, Chin-Lung
學位類別: 碩士
Master
系所名稱: 體育學系
Department of Physical Education
論文出版年: 2013
畢業學年度: 101
語文別: 中文
論文頁數: 58
中文關鍵詞: 身體活動NIRS周邊動脈栓塞
英文關鍵詞: Physical activity, NIRS, Peripheral arterial disease
論文種類: 學術論文
相關次數: 點閱:192下載:9
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 踝臂指數 (Ankle Brachial Index, ABI) 是一項用來評估周邊動脈栓塞的嚴重程度及判斷全身動脈粥狀硬化的重要指標,近年研究指出較低的ABI之老年人其心肌梗塞及中風的死亡率也較高,但ABI過高亦會導致血管鈣化,有關不同ABI老年人之身體功能和下肢氧化功能過去較少文獻探討。本研究目的比較三組不同ABI老年男性下肢肌肉氧化功能、心肺適能和身體活動量之差異,及六分鐘步行運動期間與恢復期之肌肉氧化功能之差異,同時探討心肺功能、身體活動量和肌肉氧化功能之相關。本研究招募及篩選20名年齡64~85歲男性為自願參與者,其中5位ABI<1.1為實驗A組、10位ABI介於1.1~1.3之間為正常對照組、5位ABI>1.3為實驗B組,所有受試者接受ABI指數測量、身體活動量問卷調查、六分鐘走路測驗,並利用近紅外光光譜儀 (Near Infrared Spectroscopy, NIRS) 作為肌肉氧化能力檢測工具,觀察受試者在運動前、六分鐘步行運動中及運動後恢復期的下肢肌肉氧化功能變化。所得資料以獨立樣本單因子變異數分析 (one-way ANOVA) 比較三組運動前與運動期間各項參數之差異,其顯著水準定為α=.05,再以薛費法進行事後比較,並以皮爾遜積差相關探討依變項之間的相關。結果顯示(一)正常對照組老年人每週身體活動量大於實驗兩組,而坐姿時間部分實驗A組顯著大於實驗B組 (p<.05) 。(二) 正常對照組老年人之心肺適能顯著大於實驗A組 (p<.05)。(三)三組老年人間安靜期總血紅素 (THB) 和組織氧飽和指數 (TSI%) 無顯著差異,運動期時,正常對照組老年人THB和TSI%顯著高於實驗兩組 (p<.05) 。(四)老年人心肺適能與TSI%呈顯著正相關 (p<.05) 。ABI正常組之老年男性有較大之心肺適能,運動期間下肢肌肉有較佳的氧化功能。

    Ankle Brachial Index (ABI) is an important indicator used to assess the severity of peripheral arterial embolism and systemic atherosclerosis. Recent studies have indicated the elderly with lower ABI will have higher heart attack and stroke mortality; however, too high ABI will lead to vascular calcification. The relationship between varied ABI, the physical fitness and muscle oxygenation of the elderly is unknown. The purposes of this study were to compare the difference in cardiovascular fitness (CF), physical activity (PA), muscle oxygenation among 3 ABI groups of older men, and to investigate the change of muscle oxygenation of lower extremity before, during and after 6 minutes walking. Additionally, the relationship between the CF, PA and muscle oxygenation will be investigated. Methods: Twenty male elderly aged 64-85 were recruited as the subjects following the criteria, including the experiment A group ( ABI<1.1, n=5); the normal control group (ABI 1.1~1.3, n=10) and the experiment B group ( ABI>1.3, n=5). All subjects were asked to take ABI, PA questionnaire and 6-minute walk test (for CF) , and the near-infrared spectrometer (NIRS) was used to measure the lower extremity muscle oxidative capacity before, during and recovery period of 6-minute walk. The collecting data were analyzed by independent sample one-way ANOVA to compare the differences of each variable among three groups; and to observe the change of muscle oxygenation at different period of 6 minute walk. The significance level was set at α = .05, and the Scheffe's Test post hoc comparison method was used if any significance exist. The Pearson product moment correlation was used for the correlation between the dependent variables. Results: (1) The PA per week of Normal control group is significantly greater than both experimental groups (p<.05) , while the sedentary time of the experiment A was significantly greater than group A (p<.05) . (2) The CF of Normal control group was significantly greater than that of experimental A group (p<.05) . (3) The total hemoglobin (THB) and tissue oxygen saturation index (TSI%) of 3 groups were not significant different at resting period; however, the THB and TSI% of normal control group during the 6-minute walking period were significantly higher than the both experimental groups (p<.05) . (4) The CF and the TSI% were positive significantly correlated (p<.05) . The elderly with normal ABI have better cardiorespiratory fitness and have better muscles oxygenation capacity during walking exercise.

    中英文摘要….....…………………………………………………………………………….a 目次………….……………………………………………………………………………….b 圖次………….……………………………………………………………………………….d 表次………….….…………………………………………...……………………………….e 第壹章 緒論 第一節 問題背景…………………………………………………………………..1 第二節 研究目的…………………………………………………………………..3 第三節 虛無假設…………………………………………………………………..4 第四節 名詞操作性定義…………………………………………………………..5 第五節 研究範圍…………………………………………………………………..7 第六節 研究限制…………………………………………………………………..8 第貳章 文獻探討 第一節 踝臂指數的價值與應用……………..…………………………….. ……..9 第二節 粥狀動脈硬化的危險因子………….………………………………....…11 第三節 高齡者身體活動量與心肺適能之相關研究….…………………………13 第四節 下肢肌肉組織含氧量測量之相關研究………….………………………16 第五節 文獻總結……………………………………….…………………………18 第參章 研究方法與步驟 第一節 實驗設計…………………………………………………………………19 第二節 研究對象…………………………………………………………………20 第三節 實驗儀器…………………………………………………………………21 第四節 實驗時間及場地佈置……………………………………………………23 第五節 實驗流程…………………………………………………………………24 第六節 資料收集與處理…………………………………………………………25 第肆章 結果 第一節 參與者基本資料…………………………………………………………… 26 第二節 參與者之身體活動情形…………………………………………………….27 第三節 參與者心肺適能之差異情形……………………………………………….28 第四節 參與者下肢肌肉氧合能力之情形………………………………………….31 第五節 下肢肌肉總血流量之比較………………………………………………….32 第六節 心肺適能與身體活動量及下肢肌肉組織氧合能力之相關……………….36 第伍章 討論與結論 第一節 不同踝臂指數之高齡者其每週身體活動量差異………………………… 38 第二節 不同踝臂指數之高齡者心肺適能差異…………………………………….40 第三節 不同踝臂指數之高齡者下肢組織氧化功能變項之變化情形…………….41 第四節 下肢組織氧化功能變相與身體活動量及心肺適能之相關……………….43 第五節 結論………………………………………………………………………….45 第六節 建議………………………………………………………………………….46 參考文獻 中文部分……………………………………………………………………………….47 英文部分……………………………………………………………………………….48 附錄 附錄一 參與者知情同意書…………………………………………………………53 附錄二 IPAQ台灣活動量調查問卷……………………………………………….55 圖 次 圖3-1 實驗架構圖……………………………………………………………………….19 圖3-2 安靜踝臂指數值之判讀標準…………………………………………………….20 圖3-3-1 專業型踝臂指數電子血壓計……………………………………………………..21 圖3-3-2 踝臂指數操作說明………………………………………………………………..21 圖3-3-3標準量測兩側踝臂指數之過程示意圖………………………….………………..21 圖3-3-4 近紅外光光譜儀…………………………………………..……………………….22 圖3-3-5 下肢氧合能力各參數之畫面示意圖………………………………………………22 圖3-3-6 NIRS黏貼腓腸肌位置示意圖……………………………………………………22 圖3-4-1量測安靜ABI示意圖………………………………………………………………23 圖3-4-2 室內操場實驗擺設示意圖…………………………………………………………23 圖3-5-1 氧合能力測驗流程示意圖…………………………………………………………24 圖3-5-2安靜坐姿期…………………………………………………………………………24 圖3-5-3步行運動期…………………………………………………………………………24 圖3-5-4坐姿恢復期…………………………………………………………………………24 圖4-2 三組參與者每週身體活動量之比較……………………………………………….27 圖4-3 三組受試者之心肺適能比較……………………………………….………………29 圖4-5-1各組總血紅素變化趨勢圖…………………………………………………………32 圖4-5-2各組運動期總血紅素比較圖………………………………………………………33 圖4-5-3運動減安靜_總血紅素變化量(Δ) 比較圖……………………………………….33 圖4-5-4 各組恢復期總血紅素比較圖………………………………………………………34 圖4-5-5 恢復減運動_總血紅素變化量…………………………………………………….35 圖 4-5-6恢復減安靜_總血紅素變化量…………………………………………………….35 表 次 表4-1 老年男性不同程度踝臂指數之基本資料………………………………………….26 表4-3-1各組六分鐘走路運動成績一覽表…………………………………………………28 表4-3-2實驗A組與正常對照組之心肺適能與危險因子和踝臂指數相關………………30 表4-3-3實驗B組與正常對照組之心肺適能與危險因子和踝臂指數相關………………30 表4-4 各組下肢肌肉組織氧合功能數據一覽表…………………………………………31 表4-6 心肺適能、身體活動量與運動期氧合能力變項之相關…………………………37

    一、 中文部分

    行政院內政部統計處(2012)。2012主要死因死亡人數及死亡率。統計年鑑,取自網站:
    http://www.dgbas.gov.tw

    趙婉茹、吳英黛、劉千綺 (2010)。 運動訓練對周邊動脈疾病患者周邊循環之療效:系統回顧與統合分析。 物理治療,35(1),38-50。

    陳美如、蔡世傑、陳宣志 (2006)。周邊動脈阻塞疾病。基層醫學,21(11) ,318-325。

    宣錦峰(2008)。淺談周邊動脈。義大醫訊,26(4),45-46。

    林盈利、蘇育德、林益卿(2010)。周邊動脈疾病。家庭醫學與基層醫療,25(5) ,188-195。

    李佳倫、鄭景峰 (2010)。臺灣老年人身體活動量與功能性體適能的關係。 大專體育學刊, 12(4), 79-89。

    二、 英文部分
    Allison, M. A., Hiatt, W. R., Hirsch, A. T., Coll, J. R., & Criqui, M. H. (2008). A high ankle-brachial index is associated with increased cardiovascular disease morbidity and lower quality of life. J Am Coll Cardiol, 51(13), 1292-1298.

    Allison, M. A., Ho, E., Denenberg, J. O., Langer, R. D., Newman, A. B., Fabsitz, R. R., & Criqui, M. H. (2007). Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med, 32(4), 328-333.

    Anderson, J. D., Epstein, F. H., Meyer, C. H., Hagspiel, K. D., Wang, H., Berr, S. S., . . . Kramer, C. M. (2009). Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism. Journal of the American College of Cardiology, 54(7), 628-635.

    Bauer, T. A., Brass, E. P., Barstow, T. J., & Hiatt, W. R. (2007). Skeletal muscle StO2 kinetics are slowed during low work rate calf exercise in peripheral arterial disease. European Journal of Applied Physiology 100(2), 143-151.

    Bauer, T. A., Brass, E. P., & Hiatt, W. R. (2004a). Impaired muscle oxygen use at onset of exercise in peripheral arterial disease. Journal of Vascular Surgery 40(3), 488-493.

    Brass, Eric P., Hiatt, William R., & Green, Simon. (2004). Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point — counterpoint discussion. Vascular Medicine, 9(4), 293-301.

    Collins, Langbein, W. E., Orebaugh, C., Bammert, C. , Hanson, K. , Domenic, . . . Littooy, F. N. (2005). Cardiovascular Training Effect Associated With Polestriding Exercise in Patients With Peripheral Arterial Disease Journal of Cardiovascular Nursing, 20(3), 177-185.

    Collins, Lunos, S., & Ahluwalia, J. S. (2010). Self-efficacy is associated with walking ability in persons with diabetes mellitus and peripheral arterial disease. Vasc Med, 15(3), 189-195.

    Collins, McBurney, C., Butler, J., Jelinek, C., O'Connell, S., Fritschi, C., & Reda, D. (2012). The Effects of Walking or Walking-with-Poles Training on Tissue Oxygenation in Patients with Peripheral Arterial Disease. International Journal of Vascular Medicine, 2012(985025), 1-8.

    David, C. , Lyndon, J. O., Mary, C., Andrew, W., & Leslie, I. (2001). Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheralarterialdisease. The American Journal of Cardiology 87, 324-329.

    Enright, P. L. (2003). The Six-Minute Walk Test. RESPIRATORY CARE, 48(8), 783-785.

    Fowkes, F. G. (2008). Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality -a meta-analysis. The Jourmal of the American Medical Association, 300(3), 197-208.

    Guyatt, G. H., Sullivan, M. J., Thompson, P. J., Fallen, E. L., Pugsley, S. O., Taylor, D. W., & Berman, L. B. (1985). The 6 minute walk a new measure of exercise capacity in patients with chronic heart failure. Canadian Medical Association Journal, 132(15), 919-923.

    Hamburg, N. M., & Balady, G. J. (2011). Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation, 123(1), 87-97.

    Hawkins, S. A., & Wiswell, R. A. (2003). Rate and mechanism of maximal oxygen consumption decline with aging. Sports medicine, 33(12), 877-888.

    Hiatt, W. R. (2001). Medical Treatment of Peripheral Arterial Disease and Claudication. New England Journal of Medicine, 344(21), 1608-1621.

    Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., . . . Riegel, B. (2006). ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation, 113(11), e463-e654.

    Ingle, L., Rigby, A. S., Carroll, S., Butterly, R., King, R. F., Cooke, C. B., . . . Clark, A. L. (2007). Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure. European Heart Journal, 28(5), 560-568.

    Kervio, G., Carre, F., & Ville, N. S. (2003). Reliability and intensity of the six-minute walk test in healthy elderly subjects. Med Sci Sports Exerc, 35(1), 169-174.

    Komiyama, T., Shigematsu, H., Yasuhara, H., & Muto, T. (2000). NIRS grades the severity of intermittent claudication in diabetics more accurately than ankle pressure measurement. British Journal of Surgery, 87, 459-466.

    Kooijman, H. M., Hopman, M. T. E. , Willy N. J. M. Colier, J. Adam van der Vliet, & Oeseburg, B. (1997). Near Infrared Spectroscopy for Noninvasive Assessment of Claudication. JOURNAL OF SURGICAL RESEARCH, 72, 1-7.

    Le Faucheur, A., Abraham, P., Jaquinandi, V., Bouye, P., Saumet, J. L., & Noury-Desvaux, B. (2008). Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation, 117(7), 897-904.

    Lipkin, D. P., Scriven, A. J., Ceake, T. , & Wilson, P. A. (1986). Six minute walking test for assessing exercise capacity chronic heart failure. BRITISH MEDICAL JOURNAL, 292(8).

    Malagoni, A. M., Felisatti, M., Mandini, S., Mascoli, F., Manfredini, R., Basaglia, N., . . . Manfredini, F. (2010). Resting muscle oxygen consumption by near-infrared spectroscopy in peripheral arterial disease: A parameter to be considered in a clinical setting? Angiology, 61(6), 530-536.

    McDermott, Criqui, M. H., Ferrucci, L., Guralnik, J. M., Tian, L., Liu, K., . . . Pearce, W. H. (2006). Obesity, weight change, and functional decline in peripheral arterial disease. J Vasc Surg, 43(6), 1198-1204.

    McDermott, Ferrucci, L., Guralnik, J. M., Dyer, A. R., Liu, K., Pearce, W. H., . . . Criqui, M. H. (2010). The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease. Vasc Med, 15(4), 251-257.

    McDermott, Greenland, P., Liu, K., Guralnik, J. M. , Celic, L. , Criqui, M. H., . . . Clark, A. L. (2002). The ankle brachial index is associated with leg function and physical activity : the walking and leg circulation study. Annals of Internal Medicine, 136, 873-883.

    McDermott, Liu, K., Criqui, M. H., Ruth, K., Goff, D., Saad, M. F., . . . Sharrett, A. R. (2005). Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis. Am J Epidemiol, 162(1), 33-41.

    Mohler, E. R., 3rd, Lech, G., Supple, G. E., Wang, H., & Chance, B. (2006). Impaired exercise-induced blood volume in type 2 diabetes with or without peripheral arterial disease measured by continuous-wave near-infrared spectroscopy. Diabetes Care, 29(8), 1856-1859.

    Montgomery, P. S., & Gardner, A. W. (1998). The Clinical Utility of a Six-Minute Walk Test in Peripheral Arterial Occlusive Disease Patients. Journal of the American Geriatrics Society, 46(6), 706-711.

    Mossberg, K. A. , & Fortini, E. (2012). Responsiveness and Validity of the Six-Minute Walk Test in Individuals With Traumatic Brain Injury. Physical Therapy, 92(5), 726-733.

    Parr, B. , Noakes, T. D. , & Derman, E. W. . (2008). Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication. South African Medical Journal, 98, 958-962.

    Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., . . . Turner, M. B. (2012). Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation, 125(1), e2-e220.

    Saxton, J. M., Zwierska, I., Blagojevic, M., Choksy, S. A., Nawaz, S., & Pockley, A. G. (2011). Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. Journal of Vascular Surgery 53(5), 1265-1273.

    Schroder, F., Diehm, N., Kareem, S., Ames, M., Pira, A., Zwettler, U., . . . Diehm, C. (2006). A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. Journal of Vascular Surgery 44(3), 531-536.

    Tegos, T. J., Kalodiki, E., Sabetai, M. M., & Nicolaides, A. N. (2001). The Genesis of Atherosclerosis and Risk Factors : A Review. Angiology, 52(2), 89-98.

    Yamamoto, K., Miyata, T., Onozuka, A., Koyama, H., Ohtsu, H., & Nagawa, H. (2007). Plantar flexion as an alternative to treadmill exercise for evaluating patients with intermittent claudication. European Journal of Vascular and Endovascular Surgery 33(3), 325-329.

    Yan, B. P., Lau, J. Y., Yu, C. M., Au, K., Chan, K. W., Yu, D. S., . . . Hiatt, W. R. (2011). Chinese translation and validation of the Walking Impairment Questionnaire in patients with peripheral artery disease. Vasc Med, 16(3), 167-172.

    下載圖示
    QR CODE