- 學位論文
心肺同步呼吸訓練與自我暗示放鬆訓練在心跳變異之療效
The efficacy of cardiorespiratory synchronization training and relaxation training on heart rate variability
摘要
目的：心肺同步呼吸訓練(cardiorespiratory synchronization training, CRST) 又稱心跳變異生理回饋(heart rate variability biofeedback, HRV-BF)，主要透過緩慢腹式呼吸訓練達到心肺同步狀態。過去研究已證實，HRV-BF訓練可提升休息狀態的感壓反射接受器及整體心跳變異，改善自主神經的平衡，並改善負向情緒。但尚未有研究將CRST併入穿戴式裝置結合手機APP軟體，是否優於其他心理介入方案，以及此方案在HRV訓練中之療效。 方法：採隨機分派之等組實驗設計，納入統計分析分別包含27名的心肺同步呼吸訓練組(CRST組)與29名自我暗示放鬆訓練組(relaxation training, RT)，兩組分別接受每周一次60分鐘，共四周結合穿戴裝置之CRST或RT訓練，並接受前測、四周訓練療程(含W1至W4之訓練前、訓練中、訓練後)，以及後測之HRV測量。本研究前測與後測以BioGraph Infiniti接受原始心電圖訊號，並轉換為HRV指標(包含正常心跳間距的標準差[standard deviation of normal to normal, SDNN]、低頻波[low frequency, LF]與總功率[total power, TP])；訓練中以Zephyr心率帶和MIO Alpha心率錶，透過藍芽傳輸將心跳訊號傳送至智慧型手機，再由研究人員進行HRV分析，以驗證CRST在HRV之療效。 結果：二因子變異數分析(2組*6階段)發現，CRST組在W3訓練前、W4訓練前、後測基準期的SDNN顯著高於前測及W1訓練前(F (5, 36) = 6.14, p < .001)，且CRST組在W4訓練前的SDNN顯著高於RT組(F (1, 40) = 5.12, p < .05)。CRST組的lnLF與total power自W3訓練前顯著高於W1訓練前(分別為F (3, 38) = 11.63, p < .001; 與F (3, 38) = 6.38, p < .01)。二因子變異數分析(2組*3訓練前、中、後階段)發現，CRST組的SDNN、LF在訓練中及訓練後顯著高於訓練前(分別為F (2, 37) = 20.58, p < .001; 與F (2, 37) =12.23, p < .001)；CRST組在訓練中及訓練後的SDNN與LF亦高於RT組(SDNN：F (1, 38) = 6.83, p < .05; 與F (1, 38) = 4.15, p < .05; LF：F (1, 38) =22.50, p < .001; 與F (1, 38) = 12.10, p < .01)。兩組在訓練前、中、後的改變量分析發現，CRST組在W3與W4的訓練中-訓練前HRV改變量(SDNN／LF／total power)，及W2與W3訓練後-訓練前HRV改變量(LF)顯著高於RT組。 結論：本研究結果支持心肺同步呼吸訓練結合穿戴裝置在HRV的療效顯著高於自我暗示放鬆訓練，且在第3次療程後HRV的療效顯著提升，並維持到後測；此外，在訓練中之效果亦發現訓練當下的療效可維持至訓練後。
並列摘要
Objective: The cardiorespiratory synchronization training (CRST) also known as heart rate variability biofeedback (HRV-BF), is a synchronization between heart rate and respiratory through abdominal breathing training. Previous studies have confirmed that HRV-BF can increase baroreflex gain and heart rate variability (HRV) under resting condition, therefore improving autonomic nervous system balance and negative emotions. However, a lack of study explored the efficacy of combining the CRST protocol into wearable device on HRV, as well as CRST compared with other psychological intervention programs have not been closely studied. Methods: Randomly assigned of equivalent – group experimental design was applied in this study.There were twenty-seven participants in the CRST group (CRST) and twenty-nine participants in the RT group (relaxation training, RT). Two groups received sixty minutes of CRST or RT once a week for four weeks respectively, and both received the HRV measurement at pretest before the training, under training (including pre-, mid-, and post- trainings of W1-W4), and posttest after the training. The pretest and posttest used electrocardiogram sensor with BioGraph Infiniti to collect the raw signals and transormed to HRV indices ([standard deviation of normal to normal, SDNN], [low frequency, LF], [total power, TP]). During the training sessions, participants of CRST groups put on the Zephyr heart rate monitor belt, while RT group put on the MIO Alpha heart rate monitor digital watch. Both devices through bluetooth sent heart rate signal to their mobile APP, and researchers collect the data for HRV analysis to comfirmed the effiency of HRV under CRST. Results: Two-way ANOVA (two groups * six phases) found that the SDNN of CRST group at W3, W4 pre training, and posttest was significant higher than pretest and W1 pre training (F (5, 36) = 6.14, p < .001). The SDNN of CRST group also higher than RT group at W4 pre training (F (1, 40) = 5.12, p < .05). The lnLF and total power of CRST group from W3 pre training was significant higher than W1 pre training (F (3, 38) = 11.63, p < .001; and F (3, 38) = 6.38, p < .01, respectively). Two-way ANOVA (two groups * three phases including pre-, mid-, and post- trainings) found that while CRST group was under mid- and post- trainings, the SDNN and LF were significantly higher than pre training (F (2, 37) = 20.58, p < .001; and F (2, 37) =12.23, p < .001, respectively). The SDNN and LF of CRST under mid- and post- trainings were also significantly higher than the RT group (SDNN：F (1, 38) = 6.83, p < .05; and F (1, 38) = 4.15, p < .05, respectively; LF：F (1, 38) =22.50, p < .001; and F (1, 38) = 12.10, p < .01, respectively).The analysis of HRV change scores between two groups under pre-, mid-, and post- trainings showed that CRST group has higher HRV indices (SDNN/LF/total power) in change score of mid- and pre- trainings than RT group at W3 and W4; as well as CRST group has higher HRV indices (LF) in change score of post- and pre- trainings than RT group at W2 and W3. Conclusion: This study supports CRST application for wearable device can produce better efficacy on HRV indices than RT, and show significant increase stared from W3 session to posttest. Moreover, the effect of under training also found the efficacy of HRV can increase at mid- to post trainings.