有氧運動對思覺失調症個案心理與社會功能之成效探討-隨機控制試驗

前言：思覺失調症患者相較於健康者常會有較差的心理社會功能表現。中等強度有氧運動可有助於一般族群心理與社會功能，但針對思覺失調症患者少有相關研究。研究目的：(1) 了解中等強度有氧運動對於思覺失調症患者心理與社會功能表現的成效、(2) 訓練成效是否能夠延續，以及(3) 得知個案從事結構性運動的自覺健康成效及主觀參與經驗。研究方法:本研究招募高雄市社區復健中心及日間病房的思覺失調症參與者並進行隨機分派，共有52位 (男25位，女27位) 完成運動方案，分別為伸展操控制組 (26位) 及有氧運動實驗組 (26位) ，共進行3個月。除了介入前、後以及三個月後追蹤期進行評估測驗，且在運動方案結束後各組別進行焦點團體。使用SPSS統計軟體以及ATLAS.ti version 7.0軟體，進行量性資料及逐字稿質性內容分析。結果：配對樣本t檢定統計顯示，透過參與有氧運動後可顯著提升社會功能以及增加每週總身體活動量。伸展操組參與者可以改善情緒、增加每週總身體活動量。在方案結束三個月後的追蹤評估顯示，有氧運動組其每週總活動量、社會功能表現以及復元動機有顯著提升;而伸展操組則是在憂鬱情形、每週總活動量以及運動意圖的表現有顯著持續提升。共變數分析發現，不論是後測、追蹤期兩組組間成效皆無顯著差異。質性資料顯示參與者因為少有運動經驗以至於活動初期多有身體抱怨，但回顧運動對生、心理層面的變化，大部分參與者皆有正向感受。結論: 三個月的有氧運動或伸展運動可以立即帶給思覺失調症患者在不同心理社會功能層面上的改善，且成效可以在追蹤期間繼續維持。比起運動形式的差異(有氧或是伸展運動)，持續性的身體活動參與似乎扮演更重要的角色以提升思覺失調症患者的心理與社會功能表現。未來研究建議可依不同活動類型為介入方式探討其成效，提升臨床運動方案使用時有更多的實證依據。藉此增加思覺失調症患者運動動機，強化對健康促進的概念。

關鍵字

嚴重精神疾病；健康促進；身體活動；精神復健；復元

並列摘要

Background: People with schizophrenia usually have poor psychosocial function than the general population. Moderate intensity exercise training may improve psychosocial function , but few studies were available in people with schizophrenia. The objectives of this study were s： (1) to examine the effectiveness of moderate intensity aerobic exercise on the psychosocial function in people with schizophrenia, (2) to examine the sustainability of effectiveness of exercise training, if any, on the psychosocial function , and (3) to explore the perspective of people with schizophrenia on participating in an regular exercise programs and their subjective perception on health outcomes after the exercise programs . Method：Fifty-two volunteers from community-based mental health programs and day-care were randomly assigned into the flexibility exercise group or the aerobic exercise group. The assessments were administrated at three time points: pre-intervention, post-intervention, and follow-up three months after the intervention. After the 3-month structure exercise program, both groups were invited to a focus group. Quantitative and qualitative data was analyzed with SPSS 20.0 and ATLAS.ti version 7.0; respectively. Result： The paired-t analysis showed significant improvements in the social function and increased physical activity per week for the aerobic exercise group. The flexibility exercise group experienced significant improvements in mood and the level of weekly physical activity. Follow-up assessment showed that the aerobic exercise group had significant improvements in the level of weekly physical activity , social function, and recovery to mental illness . The flexibility exercise group had significant improvements in the depressive mood, level of weekly physical activity , and intent to be physically active . But Analysis of covariance (ANCOVA) showed that no significant difference in performance between the aerobic exercise group and the flexibility group. The qualitative data revealed that volunteers had more physical complaints at the initial of program, but felt more positive feedback after finishing the group exercise. Conclusion: Three-month aerobic exercise and flexibility exercise programs could bring immediate effects on various domains of psychosocial function in people with schizophrenia. Many effects could maintain during the period of follow-up. Independent from the difference of exercise types (aerobic or flexibility) , physical exercise on a regular basis plays a more important role in the enhancement of the psychological and social performance for people with schizophrenia. It is suggested to examine the effects of different types of exercise on various health outcomes in people with schizophrenia. With more evidence-based intervention available, more people with schizophrenia would benefit health benefits from health promotion programs