經絡拳運動對社區照顧關懷據點老人自覺健康狀態及功能性體適能之成效

前言：高齡化社會乃全球性重要議題，透過適合於老人身心狀況之規律活動介入，讓缺乏運動老人得以改善其健康狀態，達到健康老化之成效，為政府及各專業努力的目標。目的：測試六個月經絡拳運動於社區照顧關懷據點老人之自覺健康狀態及功能性體適能成效。方法：採雙組、實驗性、重複測量設計，以方便取樣方式，遴選高雄市八處社區照顧關懷據點，65歲以上老人為研究對象，共收案232位，再以據點為單位，叢集隨機分派研究對象(cluster random assignment)為實驗組(n = 113)或控制組(n = 119)。實驗組接受六個月經絡拳訓練，每週三次，每次40分鐘，控制組則依原據點活動安排，無參與訓練。資料收集除個人基本資料外，以巴氏量表(Barthel Index)及簡易心智狀態量表(Short Protable Mental Status Questionnaire)做為收案篩選工具，於運動方案介入前及介入滿12週及24週時，再以結構式問卷收集個案自覺健康狀態，並以身體測量(包括肺活量、心肺功能、肩背柔軟度、坐姿體前彎、上肢肌力、下肢肌力、上肢肌耐力等)，了解研究對象之功能性體適能狀態。統計方式以描述性統計包括百分比、平均值、標準差進行統計人口學特性分析，推論性統計則以卡方、t檢定及費雪精確性檢定進行兩組差異性比較，運動介入前後之成效則以廣益估計方程式(Generalized estimating equation, GEE)進行資料分析比較。結果：經24週訓練介入後，自覺健康狀態中，實驗組之身體自覺健康狀態有顯著進步(β = 0.76，p = .033)，且顯著優於控制組(β = 2.38，p < .001)；心理自覺健康狀態則無顯著差異。功能性體適能部分，實驗組於運動介入12週後，其心肺功能(肺活量及心肺耐力)、身體柔軟度(上肢柔軟度、下肢柔軟度)、肌力及肌耐力(手握力、上肢肌耐力、下肢肌耐力)即呈現顯著進步(所有p < .001)，並持續至24週(所有p < .001)；且顯著優於控制組(所有p < .001)。討論：經絡拳運動是一套短期(12週)內即可改善社區老人體適能狀態之運動，讓參與者得以感受其對身體之助益，並願意持續進行。社區老人運動之推動，應多以老人接受度高、簡易、創新之活動加以設計，如此可讓活動深耕於社區，促進社區老人健康。

關鍵字

功能性體適能；自覺健康狀態；社區老人；養生律動經絡拳

並列摘要

Abstract Introduction: Aging is a global crucial issue; successful ageing through adopted suitable and regular activities is government and every professional’s purpose. Purpose: The study adopted Health Beat Acupunch Exercise Program (HBA) for six months as a tool for testing the effects of self-rated health status and functional fitness toward seniors of community care centers. Methods: The study adopted quasi-experimental and repeated measure design. The subjects focused on seniors aged 65 years old or above at 8 Kaohsiung community care centers, polling a total of 232 subjects, whom, by their willingness, were grouped into experiment group (n=113) and control group (n=119) in accordance with cluster random assignment based on the community care centers. The experiment group received Health Beat Acupunch Exercise Program 40 minutes in one time, and three times a week. The control group did not receive the program training but the original activities which were provided by community care centers. Except for demographic data collecting, we used Barthel Index and Short Protable Mental Status Questionnaire SF-12 as a screening tool, structured questionnaire as a collecting tool to gather data, before and after the training program in 12-week and 24-week, and used physiological measurement (which included vital capacity, cardiorespiratory endurance, upper-extremity flexibility, sitting forward reach test, upper limb muscle strength, lower limb muscle strength, upper limb muscle endurance, and so on.) to understand the effects of functional fitness. Descriptive statistics included percentage, mean value and standard deviation to analyze data and inferential statistics used a chi-square test, T test and fisher’s exact test to compare the differences between two groups. Generalized estimating equation (GEE) was used to analyze the effects before and after the exercise regimen. Results: After 24-week exercise program, there was a significant improvement in the experiment group on physical component summary (PCS) (β = 0.76，p = .033) and better than the control group (β = 2.38，p < .001). There is no significant difference on mental component summary (MCS). After 12-week exercise program, the significant improvement of functional fitness included cardiopulmonary function (including vital capacity and cardiorespiratory endurance), body flexibility (including upper-extremity flexibility and lower-extremity flexibility), muscle strength and muscle strength endurance (including hand-grip strength, upper limb muscle endurance and lower limb muscle endurance) (p < .001) and better than control group (p < .001). Discussion: Health Beat Acupunch Exercise Program (HBA) can improve community seniors’ physical fitness in short time (12 weeks); therefore, participants can understand the benefits of health and willing to proceed. The strategies for community elderly exercise impetus should provide acceptable and innovative activities so that they can operate in community to achieve the goal of healthy aging.