運動有效降低臨床醫療花費

Physical Activities Reduce Medical Expenses

黃森芳(Sen-Fang Huang) ； 陳杰(Chieh Chen)

《北市醫學雜誌》 17卷3期 (2020/09) Pp. 257-271

https://doi.org/10.6200/TCMJ.202009_17(3).0002

摘要

臺灣非傳染性疾病（Non－communicable Diseases, NCDs）的發生率與世界同步，約占十大死因的70%。NCDs可以是長期和緩慢進展的慢性病，例如：自體免疫性疾病、肺阻塞、氣喘等慢性呼吸系統疾病，其併發症也可能導致更快的死亡，例如：突發性中風、心肌梗塞等。我國人口老化快速是目前台灣社會面臨的另一項挑戰；人口老化愈嚴重，非傳染性疾病死亡率就愈高。事實上，台灣老年人口比率早於1993年達到「高齡化社會」標準，而2018年3月已超過14%，成為「高齡社會」；推估2026年更將超過20%，達到「超高齡社會」。除了人口結構改變，青年人的負擔增加之外，老人慢性病及癌症醫療將是一個迫切而且不得不面對的課題。本研究搜尋PubMed、Medline、Cochrane library、Google scholar等資料庫，以關鍵字：physical activity、cost、health literacy、exercise prescription 等回顧歐美等國外運動風氣盛行的國家所研究之文獻（介於2011至2020十年之間），在身體適能與住院醫療支出的經濟效能方面，來做為台灣全民健康保險制度下推行運動的政策借鏡。透過運動生理、病理學、分子生物學、流行病學與臨床研究證實，運動可以啟動多重強化身體健康路徑的訊號，也證實規律運動可以預防肌少症、肌少型肥胖、胰島素阻抗、高血壓、中風、代謝症候群、骨質疏鬆、肥胖、乳癌、結腸癌、子宮內膜癌、憂鬱症等35項慢性健康問題。研究更進一步證實身體適能、醫療支出或保健花費與性別、年齡、BMI、腰圍、健康或亞健康、有無糖尿病之間呈現高度相關，因此建議國人提升身體活動量或心肺適能達某一定程度，每年醫療保健支出即會明顯下降，特別是年長者的住院風險也可以明顯減少。

關鍵字

醫療保健支出 ； 心肺適能 ； 代謝當量 ； 臨床運動指導員 ； 運動處方

並列摘要

The incidence of non-communicable diseases (NCDs) in Taiwan is in the same pace with the world which accounts for 70% of the major causes of death in the country. NCDs can be chronic and with slow progression while the complications can lead to faster deaths, such as stroke, myocardial infarction, etc. NCDs include autoimmune diseases, chronic respiratory diseases such as ACOS (Asthma-COPD overlap syndrome), heart disease, stroke, most of the cancers, diabetes, chronic kidney disease, osteoporosis, dementia, etc. The rapid population aging is another challenge of Taiwan society at present. The more severe the population ages, the higher the mortality rate of NCDs. An aging society is defined when the elderly accounts for 7 % of the total population and an aged society is defined when the proportion of the elderly population exceeds 14%. The proportion of the elderly population in Taiwan had already reached 7% in 1993 and 14% in 2018. It is estimated that the population older than 65 years will be more than 20 % in 2026 and become Taiwan will become a ''super-aged society'' at that time. Besides from demographic changes, the burden on young people will increase, and the elderly population with chronic diseases and cancer will become an urgent problem to be confronted. We searched literatures from the PubMed, Medline, Cochrane library and Google scholar using keywords including physical activity, cost, health literacy, exercise, and prescription. We reviewed literatures of the European countries and American in which sports are popular so that their experiences can be adapted and referenced in our economic performance of physical fitness and hospitalization expensing under the current health insurance system policy. Exercise physiology, pathology and molecular biology studies have confirmed that exercise can initiate multiple signals that strengthen body's health pathways; previous epidemiological and clinical researches have also confirmed that regular exercises can at least prevent sarcopenia, metabolic syndrome, and other 35 type of chronic diseases like hypertension, stroke, osteoporosis, cancer, and depression. Studies have confirmed that fitness, medical expenditure, health care costs are highly correlated with gender, age, BMI, waist circumference, health and optimal health, and diabetes. Improve the amount of physical activity or cardiopulmonary fitness to a certain extent would reduce the annual health care expenditure as well as the re-hospitalization risk of the elderly.

並列關鍵字

health care costs ； cardiopulmonary fitness ； metabolic equivalent of task ； clinical exercise physiologist ； exercise prescriptio