阻力運動訓練對中老年人次閾值憂鬱之效果：先導隨機對照試驗

The Effect of Resistance Exercise Training on Subthreshold Depression among Middle-aged and the Elderly Population: a Pilot Randomized Controlled Trial

吳怡萱(Yi-Hsuan Wu)

指導教授 ： 張書森

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2018年)

https://doi.org/10.6342/NTU201801802

摘要

人口老化是當前所關注的公共衛生議題，老化將會帶來生理及心理上的影響，而憂鬱症在中老年族群相當常見。具有憂鬱症狀但未達臨床診斷標準之個案，可將其定義為次閾值憂鬱（subthreshold depression），此種情形在一般人口中不算少見，例如一項針對南台灣地區1,500名65歲以上的老人的調查，具老年憂鬱症狀一個月盛行率為21.3%，其中罹患重度憂鬱症為5.9%，而其它可稱之次閾值憂鬱。中老年族群因年齡於疾病上的表現、或是中老年人較少表現出憂鬱的情緒等因素，導致次閾值症狀不容易被發現，且缺乏治療。次閾值憂鬱不僅會影響生活品質，也可能會進展成重度憂鬱症。針對次閾值憂鬱的介入可望改善憂鬱症狀與生活品質，並避免進展到重度憂鬱症。

過去研究發現身體活動的介入對於憂鬱症有正向的影響。大多數研究是針對有氧運動介入（aerobic exercise training, AET）進行探討，然而此種介入可能不適合體能情形較差的中老年人。相較於有氧運動，阻力運動訓練（resistance exercise training, RET）更可增加肌力及骨頭密度、改善身體平衡，以及也可能有助於提升心理健康。阻力運動是藉由關節與肌肉組織的對抗阻力作用，以達到肌肉強化、及刺激骨密度增加的目標。本研究欲探討阻力運動訓練對中老年人次閾值憂鬱的影響。

本研究以到羅東聖母醫院門診就醫、參加癌症篩檢、或擔任志工之中老年族群為對象，13名參與者（平均年齡63.2±9.3歲）符合次閾值憂鬱之定義（台灣老年憂鬱量表 [Taiwan Geriatric Depression Scale, TGDS-30] 總分介於8-19分），以隨機方式分配到運動方案介入或控制組（發予運動衛教單張）。介入組進行每週1次、每次約60分鐘，並持續10週的阻力運動訓練課程。測量變項為憂鬱症狀、認知功能，生活品質及功能性體適能。利用配對t檢定探討兩組組內前測及後測之差異，另以曼惠特尼U檢定及廣義估計方程式比較兩組前後測改變量之差異。

研究結果發現，相對於控制組（n=6），實驗組（n=7）之TGDS分數下降值較多，且部分功能性體適能改善程度較大，包括下肢肌力（30秒椅子站立）、下肢柔軟度（椅子坐姿體前彎）、靜態平衡能力（開眼單足立）、動態平衡能力與敏捷性（椅子坐立繞物）等，然而，以上差異均未達統計顯著差異（p＞0.05）。

本研究發現阻力運動訓練對於中老年次閾值憂鬱者或有幫助，但因樣本數不足，未能確認介入之有效性。未來研究可以朝向增加樣本數，與改進介入實施容易度等方向進行努力。若阻力運動訓練對於次閾值憂鬱之效果能得到確認，將有潛能成為社區中減緩憂鬱症狀的一個選項。

關鍵字

中老年 ； 次閾值憂鬱 ； 阻力運動訓練 ； 隨機對照試驗

並列摘要

Population ageing is a public health issue that is attracting attention. Aging would impact on not only physical but also psychological health, and depressive disorders are common in the middle-aged and elderly population. Subthreshold depression can be defined as a constellation of depressive symptoms that is insufficient to make a diagnosis of major depression; however, it is not uncommon in the general population. For example, a community study based on 1500 participants aged 65 and over from South Taiwan showed that the 1-month prevalence rate of depressive disorders was 21.3%; 5.9% fulfilled the diagnostic criteria of major depression, and the rest could be seen as having subthreshold depression. Subthreshold depression is under-detected and under-treated in the middle-aged and elderly population as the symptoms were commonly masked by physical illness or depressive mood was seldom reported in this population. Subthreshold depression would not only impact on the quality of life but also may progress to major depressive disorder. Interventions for subthreshold depression may reduce depressive symptomatology, improve the quality of life, and prevent the onset of major depression.

Previous studies show that physical activity interventions have positive impacts on depression. Most research focuses on aerobic exercise training (AET) interventions, which may not be appropriate for the older population who has poorer physical conditions. Compared to aerobic exercise training, the resistance exercise training (RET) has the benefits of increasing muscular strength and bone density, improving body balance, and perhaps enhancing mental health. Resistance exercise can strengthen muscle and stimulate bone growth by training the joints and muscles against an applied force. This study was aimed to investigate the effect of resistance exercise training on subthreshold depression among the middle-aged and elderly population.

The participants of this study were middle-aged or elderly outpatients, individuals who participated in cancer screening, or hospital volunteers at Luo-Dong Saint Mary’s Hospital. The 13 participants (aged 63.2±9.3 years) were assessed using the Taiwan Geriatric Depression Scale (TGDS-30) and had a total score of 8-19. Participants were randomly assigned to the resistance exercise training intervention group or the control group, to which an educational sheet about physical activity was given. Participants in the intervention program group received a resistance exercise training program, once a week, 60-minute a session, for 10 weeks. All participants were assessed for the following twice before and after the intervention: depressive symptoms, cognitive function, quality of life, and physical fitness. Paired t test was used to analyze the within-group before-and-after differences. Mann-Whitney U Test and Generalized Estimating Equation were used to examine the effect of the resistance exercise training intervention program.

We found that the TGDS-30 score decreased more in the intervention group (n=7) than in the control group (n=6). Compared to the control group, participants in the intervention group improved more in physical fitness including the lower body strength (30s chair stand), lower body flexibility (chair sit-and-reach), static balance ability (one leg stand), dynamic and agility balance ability (up and go). However, there was no statistical evidence for any of the above differences (p＞0.05).

The findings suggest beneficial effects of resistance exercise training on subthreshold depression among the middle-aged and elderly population. However, the effectiveness of the intervention could not be confirmed due to small number of participants. Future trials should increase the number of participants and improve the ease with accessing the intervention. If the effect of resistance exercise training on subthreshold depression can be confirmed, such intervention may have the potential to become an accessible option to alleviate depression symptoms in the community.

並列關鍵字

Middle-aged and the Elderly Population ； Subthreshold Depression ； Resistance Exercise Training ； Randomized Controlled Trial

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