台灣船員運動行為和心血管疾病風險因子的關聯

The Relationship Between Exercise Behavior and Coronary Risk Factors among Taiwan Seafarers

陳建佑(Chien-Yu Chen)

指導教授 ： 郭藍遠

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2017年)

摘要

台灣船員的健康問題，在國內目前仍是未獲重視的問題。研究指出，商船上若發生自然死亡事件，心血管疾病就佔了55%~70%的原因。而規律且充足的身體活動已被證實可以降低心血管疾病的發生率及死亡率。鑒於國內以往關於船員心血管疾病盛行率的研究，主要是透過問卷調查及訪談結果分析，目前仍缺乏由體檢單位端客觀的觀察驗證。故本研究是借船員來院接受「船員體格健康檢查」的時機，探討船員的運動行為和心血管疾病風險因子之間的關係。本研究目的為結合問卷與體檢時的客觀數值，探討海上或陸上運動行為跟身體質量指數（Body Mass Index, BMI）、血脂肪、胰島素阻抗的關聯性如何、不同的職位的船員是否會有不同的健康特性。
本研究有142位受試者，所有受試者皆需量測身高、體重、血壓、心電圖、慣用手最大握力，並填寫身體活動量調查問卷(International Physical Activity Questionnaire ,IPAQ)、健身運動行為調節問卷(Behavioural Regulation in Exercise Questionnaire-2, BREQ-2)與受試者同意書。其中102位有配合空腹8小時以上到檢，故將其血脂肪、糖化血色素、胰島素阻抗(HOMA-IR)數值再做進一步分析。統計方法依不同狀況使用Spearman，s rank correlation來看各變項相關性，或使用Mann-Whitney U-test、Kruskal-Wallis test來比較各組差異。對於符合常態分佈的連續變項採用獨立樣本t檢定或one-way ANOVA。為了確認兩兩變項之關係，視狀況放入已知的危險因子和統計方法篩選出來的變項，以執行多變項線性迴歸分析。
研究結果顯示：甲級船員的海上身體活動量明顯低於乙級船員，但是在陸上的身體活動量兩組間並沒有明顯的差異。坐式生活的時間和船員的BMI數值呈現正相關(p<0.05)；海上坐式生活的時間和三酸甘油脂有顯著正相關(p<0.0001)。身體活動量方面，發現船員回到陸岸上的坐式生活的時間、運動頻率和相對自主性指數(RAI)具有正相關性(p<0.05)；而50~60歲的船員族群，他們陸上的身體活動量、運動頻率和胰島素阻抗(Insulin resistance)呈現負相關(p<0.05)。BREQ-2的各構面，又以認同調節、內在動機和運動行為關係最大。在具有運動健身設備的船上工作的船員，他們在海上的身體活動量確實較高。
所以，我們首先應該要關心身體活動量偏低、坐式生活時間過長的船員族群，而運動動機問卷可能會給我們一些該如何介入的訊息；然後試著符合他們的個人需求，以提升他們的運動動機並同時改善船上的運動設施，對船員心血管疾病的預防應該是有所助益的。

關鍵字

船員 ； 運動行為 ； 心血管疾病

並列摘要

Background:
Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. Seafarers face very specific job-related cardiac risk factors, such as time pressure, high stress factors onboard, or long working hours. In the 1980s and 1990s, deaths due to cardiovascular disease accounted for 55% to 70% of all natural causes of death among seafarers on British and Danish merchant ships. The coronary heart disease（CHD﹚risk is influenced by independent coronary risk factors, namely age, LDL cholesterol, smoking, HDL cholesterol, systolic blood pressure, family history of a premature myocardial infarction, diabetes, and triglycerides, as well as dependent risk factors, i.e. overweight, lack of exercise, high-fat diet, alcohol and stress. However, research which has empirically documented the link between Taiwan seafarers’ exercise behavior and coronary risk is scant. In this study, the association among exercise behavior, handgrip strength, insulin resistance, lipid profiles, job-relative factors（rank, workplace﹚were assessed.
Methods:
The study employed a cross-sectional design on the health characteristics of seafarers. Data collection from Jan. 2016 to Oct. 2016. In total 142 male seafarers aged 30-60 years were recruited from a health evaluation center at the Zuoying branch of Kaohsiung Armed Forces General Hospital. Their exercise behavior were assessed using the International Physical Activity Questionnaire (IPAQ) short form and Behavioral Regulation in Exercise Questionnaire-2(BREQ-2). In addition, insulin resistance(HOMA-IR), handgrip strength, lipid profiles were also measured. We investigated the influence of exercise behavior on coronary risk factors.

Results:
The study participants were, on average, 43.70±9.45 years old and had a median body mass index (BMI) of 26.5[24.1 to 28.9] kg/m2. At sea, non-officers were more likely to be physical active than officers (p<0.01). IPAQ-reported sitting time and body mass index were observed about their positive relationships (p<0.05). The findings show that IPAQ-reported sitting time at sea was significantly correlated with triglyceride (p<0.0001). IPAQ-reported sitting time on land and exercise frequency on land were associated with relative autonomy index (RAI) (p<0.05). MET minutes of activity on land and exercise frequency on land were associated with HOMA-IR in men aged 50 to 60(p<0.05). In the motivation profile, identified regulation and intrinsic regulation appeared to be important determinants of exercise behavior on land (p<0.05). To provide fitness equipment onboard is positively correlated with MET minutes of activity at sea (p<0.05).

Conclusion:
Recommended the seafarers engaging in various physical activity, increasing physical activity levels, and decreasing sedentary behavior time in order to achieve the purpose of cardiovascular disease prevention. In health promotion programs, BREQ-2 could be used as a clinical tool for seafarers’ participatory motives evaluation.

並列關鍵字

seafarers ； exercise ； physical activity ； coronary risk factors

參考文獻

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