水中與陸上高強度間歇運動課程對停經後婦女心血管健康之影響

Effects of Water- and Land-based High-intensity Interval Training on Cardiovascular Health Related Parameters in Postmenopausal Women

楊婷貽(Ting-Yi Yang)

指導教授 ： 錢桂玉

共同指導教授 ： 林信甫(Hsin-Fu Lin)

國立臺灣大學/共同教育中心/運動設施與健康管理碩士學位學程/碩士(2021年)

https://doi.org/10.6342/NTU202104279

摘要

目的：比較水中跳躍與陸上階梯高強度間歇訓練對停經後婦女心血管健康之影響。方法：招募57位停經後婦女 (61.6 ± 5.2歲)，分為水中運動組 (aquatic exercise, AE, n=19)、陸地運動組 (land exercise, LE, n=24) 與控制組 (Control, CON, n=14)。本研究為期16週，AE組與LE組介入每週 3 次，每次 42.5分鐘的間歇運動，高運動強度為 75-80% 儲備心跳率 (heart rate reserve, HRR) 或運動自覺強度(RPE) 6-8，動態恢復50% HRR。CON 維持日常生活模式。實驗前後檢測心血管健康相關指標：檢測指標包括心率變異度 (Heart rate variability, HRV)、血管硬度指數、血壓、一氧化氮 (Nitric Oxide, NO)、胰島素阻抗指標 (Homeostasis Model Assessment-Insulin Resistance, HOMA-IR) 、發炎指標高敏感度C-反應蛋白 (hs-CRP) 與腫瘤壞死因子-α (Tumor Necrosis Factor, TNF-α)，以及分析飲食攝取。結果：單純主要效果：AE組：取自然對數之心率變異度指標正常心跳間期的標準差 (natural logarithm Standard deviation of NN intervals, Ln SDNN) 與低頻範圍正常心跳間期之變異數 (natural logarithm Low Frequency power, Ln LF) 後測顯著高於前測 (Ln SDNN: 3.67±0.38 vs. 3.31±0.26 ms, p<0.001; Ln LF: 4.95±1.04 vs. 4.18±0.64 ms2, p=0.001)。LE組：TNF-α、HOMA-IR與體脂肪率後測顯著低於前測 (0.43±0.3 vs. 0.78±0.5 pg/mL, p<0.001; 1.47±1.09 vs. 2.14±1.34, p<0.001; 31.08±4.4 vs. 32.13±5.3 %, p=0.046)，骨骼肌重後測顯著高於前測 (20.72±2.83 vs. 20.51±2.63 kg, p=0.028)。另外，飲食脂肪攝取AE與LE後測皆顯著高於前測 (AE: 76.8±33.5 vs. 65.5 ±17.3 g, p=0.037; LE: 73.0±15.1 vs. 59.9 ±17.7 g, p=0.024)。整體時間主要效果：相鄰正常心跳間期差值平方和的均方根 (The square root of the mean of the sum of the squares of differences between adjacent NN interval , RMSSD)、高頻範圍正常心跳間期之變異數 (High Frequency power , HF)、低頻範圍正常心跳間期之變異數 (Low Frequency power, LF)、全部正常心跳間期之變異數高頻、低頻、極低頻的總和 (Total Power, TP) 皆後測顯著高於前測 (RMSSD: 27.49±13.1 vs. 19.90±8.6 ms, p<0.001; HF: 147.41±24.4 vs. 78.79±8.6 ms2, p=0.008; LF: 157.98±25.3 vs. 94.43±9.7 ms2, p=0.001; TP: 649±65.0 vs. 412.60±28.9 ms2, p<0.001)，安靜心率後測顯著低於前測 (65.04±7.5 vs. 68.60±8.4 bpm, p<0.001)，血清NO後測顯著高於前測 (37.01±15.3 vs. 25.00±10.3 mM, p<0.001)。飲食熱量攝取與碳水化合物後測顯著高於前測(1778±337 vs. 1575±279 kcal, p=0.001; 209±43 vs. 184±44 g, p=0.003)。結論：水中運動環境之高強度間歇運動介入顯著增加停經後婦女心率變異度，而陸地高強度間歇運動在身體組成、胰島素阻抗值以及TNF-α有顯著改善。

關鍵字

自律神經 ； 心率變異度 ； 身體組成

並列摘要

Purpose: Compare the effects of high-intensity interval training in water-based jumping and land-based steps on cardiovascular health related parameters in postmenopausal women. Methods: 57 postmenopausal women (61.6 ± 5.2 years old) were recruited and divided into aquatic exercise (AE, n=19), land exercise (LE, n=24) and Control group (CON, n=14)。Exercise group completed the course for 16 weeks, 3 times a week, 42.5 minutes each time, with a high exercise intensity of 75-80% heart rate reserve (HRR) or rate of perceived exertion (RPE) 6-8 intermitted active recovery of 50% HRR. CON maintained daily life. Cardiovascular health related parameters were measured before and after the intervention, including heart rate variability, arterial stiffness index, blood pressure, nitric oxide (NO), Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), high sensitive-CRP, Tumor Necrosis Factor(TNF-α) and dietary intake assessment。Results: Simple interaction effect: AE: Natural logarithm Standard deviation of NN intervals (Ln SDNN) and natural logarithm Low Frequency power (Ln LF) was higher in post-test (Ln SDNN: 3.67±0.38 vs. 3.31±0.26 ms, p<0.001; Ln LF: 4.95±1.04 vs. 4.18±0.64 ms2, p=0.001). LE: TNF-α, HOMA-IR and bodyfat were lower in post-test (0.43±0.3 vs. 0.78±0.5 pg/mL, p<0.001; 1.47±1.09 vs. 2.14±1.34, p<0.001; 31.08±4.4 vs. 32.13±5.3 %, p=0.046). Dietary fat intake was higher after intervention in AE and LE group (AE: 76.8±33.5 vs. 65.5 ±17.3 g, p=0.037; LE: 73.0±15.1 vs. 59.9 ±17.7 g, p=0.024). Main time effect: The square root of the mean of the sum of the squares of differences between adjacent NN interval (RMSSD), High Frequency power (HF), Low Frequency power (LF) and Total Power (TP) were higher in post-test (RMSSD: 27.49±13.1 vs. 19.90±8.6 ms, p<0.001; HF: 147.41±24.4 vs. 78.79±8.6 ms2, p=0.008; LF: 157.98±25.3 vs. 94.43±9.7 ms2, p=0.001; TP: 649±65.0 vs. 412.60±28.9 ms2, p<0.001). The resting heart rate was lower in post-test (65.04±7.5 vs. 68.60±8.4 bpm, p<0.001), and serum NO was increased in post-test (37.01±15.3 vs. 25.00±10.3 mM, p<0.001). Caloric and carbohydrate intake were higher in post-test. (1778±337 vs. 1575±279 kcal, p=0.001; 209±43 vs. 184±44 g, p=0.003). Conclusion: Water-based high-intensity interval training significantly increases the heart rate variability of postmenopausal women. Land-based exercise group significantly improved body composition, HOMA-IR and TNF-α.

並列關鍵字

Autonomic nervous system ； heart rate variability ； body composition

參考文獻

1. Gordon BJ, Eddie J, Johnson JE, Korol O, Kruse HD, Brandon P, James WA, Womble M, Kelly YA. Anatomy physiology. Houston: OpenStax College, Rice University, 2017.

2. Reid IA. Interactions between ANG II, sympathetic nervous system, and baroreceptor reflexes in regulation of blood pressure. American Journal of Physiology-Endocrinology And Metabolism 262: E763-778, 1992.

3. Clark H. NCDs: a challenge to sustainable human development. The Lancet 381: 510-511, 2013.

4. Mensah GA, Roth GA, and Fuster V. The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond. Journal of the American College of Cardiology 74: 2529-2532, 2019.

5. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G,… Murray C. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. Journal of the American College of Cardiology 70: 1-25, 2017.