半監督式運動處方於南台灣病態性肥胖病患接受胃袖狀切除手術後心肺適能、身體組成改變與減重成效之關聯:一年成果分析

Cardiopulmonary Fitness, Anthropometric Changes, and Weight Loss Effect of “Semi-Supervised Exercise Program” after Sleeve Gastrectomy among Southern Taiwanese Morbidly-Obese Patients: One-Year Result

張博智(Po-Chih Chang)

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

研究背景:
飲食與體適能運動是維持減重手術後持續體重下降的不二法門，在所有的運動處方中，直接監督式的運動處方是最有效，但也是最不方便且又缺乏隱私的！而所謂的半監督式運動處方(Semi-Supervised Exercise Program)，則是由體適能教練於門診開立處方，由病患自己執行體適能運動，藉由自覺量表來調整運動強度，最後在門診追蹤時來驗收平日運動的成果，則是有著較人性和遵從性較佳的優勢。
研究目的:
於南台灣某國際認證的減重手術卓越中心，針對病態性肥胖病患於腹腔鏡胃袖狀切除手術後，施行半監督式運動處方，來評估其成效！
研究方法:
於2014年1月至2016年5月進行前瞻隨機對照試驗，於接受腹腔鏡胃袖狀切除手術後第四個月起，兩組的受試者開始執行所開立的運動處方，每個星期的時間總和為150分鐘至200分鐘的中等強度以上的有氧運動，執行完的當下再輔以伯格自覺盡力程度量表(Borg Rating of Perceived Exertion Scale)來評估其強度，在實驗組的部分，則是多開立每兩個星期一次，每次30分鐘，於體適能教練直接目視監督下的快走運動，最終則於減重手術後的第三、六和十二個月底回診時，檢測其體重、體脂和六分鐘行走測試結果並紀錄之！
研究結果:
在50位受試者中，最後有22位完成全部的試驗，剛好平均分布於兩組；除了年齡以外(30.0±4.6 vs. 40.2±10.8歲，p=0.013)，其他性別、身高或體重分布統計並無統計學上的差異，而在手術後一個月分析，體重、體脂肪或六分鐘行走測試結果，也無因年齡之不同而有統計學上的差異；在手術後一年，實驗組和控制組的過多體重減輕分別為78.0±13.1% 和73.6±17.6% (p>0.05)，而六分鐘步行測試也都有著顯著的改善；此外，比起對照組，實驗組於整體體脂肪減少(34.1±11.5% vs. 23.8±10.2%, p=0.039)、內臟脂肪減少(68.5±10.7% vs. 54.7±11.8%, p=0.01)和皮下脂肪減少(54.0±10.5% vs. 43.8±10.2%, p=0.033)，則是有統計學上的顯著差異！
結論:
不僅只是減去更多的過多體重，比起單純地遵循體適能師所開立的運動處方並自己執行者，在腹腔鏡胃袖狀切除手術後一年，半監督式體適能運動處方介入的病態性肥胖族群有著更多的體脂肪減輕和更好的心肺適能表現。

關鍵字

病態性肥胖 ； 減重手術 ； 體適能運動 ； 心肺適能 ； 身體組成

並列摘要

Background:
Exercise program and diet education are essential to maintain healthy and sustained weight loss after bariatric surgery. Among all exercise programs, supervised exercise program remains the most efficient, but inconvenience and lack of privacy are the issues. “Semi-Supervised Exercise Program” (SEP) is based on outpatient clinic’s fitness instruction and demonstration, taking exercise privately, feedback from official perceived exertion scale, and validation of clinical efficacy during follow-up, has the advantages of good adherence and humanized.
Objective:
We review our experience of conducting SEP for Taiwanese morbidly-obese patients after laparoscopic sleeve gastrectomy (LSG) at a Center of Excellence and analyze its clinical effects.
Materials and Methods:
A prospective, randomized trial was performed for LSG cases between January 2014 and May 2016. The exercise protocol was started three months after surgery to prevent the weight loss from suboptimal caloric ingestion. Both control and SEP groups were prescribed with the same exercise program (150-200 minutes fast walking per week) and questionnaires validating with Borg rating of perceived exertion scale sooner after exercise except prescribing a course of semi-supervised exercise for the SEP group. The data included patients’ demographics and body composition analysis. The pre-intervened and post-intervened 6-minute walk test was performed as physical fitness indicator for all patients at 3, 6, and 12 months after initial surgery.
Results:
Out of 50 patients enrolled initially only 22 patients were eligible throughout the study (11 patients in each group). There was no difference of patients’ demographics (except age, 30.0±4.6 vs. 40.2±10.8 years, p=0.013), body weight, body mass index, and body composition analysis between these 2 groups. One-year excess weight loss of these two groups were 78.0±13.1% vs. 73.6±17.6% (p>0.05). Both groups had significant improvement in physical fitness irrespective of intervened status (641.2±50.5m vs. 571.4±93.7m, p=0.034); moreover, the SEP group resulted in a significant improvement in total body fat reduction (34.1±11.5% vs. 23.8±10.2%, p=0.039), visceral fat reduction (68.5±10.7% vs. 54.7±11.8%, p=0.01), and subcutaneous fat reduction (54.0±10.5% vs. 43.8±10.2%, p=0.033) after 9-month intervention.
Conclusions:
Not just more excess weight loss, SEP is superior in subcutaneous and visceral fat reduction than the control group at one year after initial sleeve gastrectomy. Longer follow-up is warranted to draw a definite conclusion.

並列關鍵字

Anthropometric Changes ； Bariatric Surgery ； Cardiopulmonary Fitness ； Exercise ； Morbid Obesity

參考文獻

中文參考文獻

1. 衛生福利部國民健康署肥胖防治網(2016)(http://obesity.hpa.gov.tw/TC/ faqContent.aspx?id=67&chk=84b32626-2bca-430c-982b-784a9b53fe69¶m=pn%3D3)

2. 衛生福利部全球網站中文版(2016)(http://www.mohw.gov.tw/cp-16-33598-1.html)

3. 高醫體重管理中心減重手術比較(2016) (http://www.wmkmuh.com/wp-content/uploads/2016/08/門診手術減重手術比較.jpg)

4. 台灣代謝及減重外科醫學會年報 (2010-2016) (http://www.tsmbs.org.tw/p5-statistics.asp)