不同比例負能量平衡監控介入對年輕肥胖女性體適能及心臟血液動力學的影響

肥胖者較易導致心血管疾病和體適能不佳，而增加身體活動量和減少能量攝取是控制體重之原則，過去研究中，罕見以不同運動及飲食比例之負能量平衡監控系統來控制體重。目的：本研究主要在探討十二週不同負能量平衡比例監控介入對年輕肥胖女性身體適能及心臟血液動力學的影響。方法：本研究招募53位健康年輕肥胖女性(平均年齡21.74±1.8；BMI29.8±2.7)，隨機分派為：熱量限制監控組(CRM，100%飲食負平衡)、身體活動監控組(PAM，100%身體活動負平衡)、熱量限制及身體活動監控組(50% CRM + 50% PAM負平衡, CPM)三組實驗組及控制組(CG，不予控制)等四組；其中CRM, PAM, CPM三組實驗組進行12週介入，每週減重0.5公斤，並在第0(第1階段)、7(第2階段), 13(第3階段)週，進行體適能及心臟血液動力學評估；所收集資料統計方法以Two-Way Mixed ANCOVA、Repeat t test、One-Way ANOVA進行各項分析比較(α=.05)；結果：一、階段與群組差異：體重(W)、身體質量指數(BMI)、體脂肪%(FAT%)、腰圍(WC)、臀圍(HC)、3分鐘登階耐力指數(EI)等參數參數，明顯在第3階段優於CG組；二、前後差異：1. 身體組成參數：W, BMI、除脂肪量(FFM), W, HC在CRM, PAM, CPM三組; FAT%在PAM, CPM兩組; WHR在CG, CPM組介入後顯著改善； 2.體能參數：6分鐘走路距離(WD_6min)在CRM, PAM, CPM三組; 立定跳遠(LJ)、EI在CRM, CPM組;CU60s在PAM, CPM組介入後有明顯增加； 3.心臟血液動力學參數：第1-3階段在心搏出量(SV)、心搏指數(SVI)、收縮末期容積(ESV)、射血分數(EF%)僅在PAM組、第2-3階段SV, SVI僅在PAM組有明顯進步。三、前後變化量差異：1.身體組成變化量(Difference, _D)參數：W_D, BMI_D, FAT%_D, WC_D, HC_D等參數變化量在CRM, PAM, CPM三實驗組；腰臀圍比例(WHR_D)在CPM組皆明顯優於CG組；2. 體能變化量：CU60s_D在PAM組；EI_D在CRM, CPM組；WD_6min_D在CRM, PAM, CPM三組均明顯優於CG組。結論：十二週不同比例之身體活動及飲食負平衡監控介入皆能改善體適能，但只有PAM組顯著改善心臟血液動力學，於減重過程中，提高身體活動量較能改善心臟功能。

關鍵字

肥胖；心輸出量；心搏出量；心室射血分數；能量平衡

並列摘要

Obesity is likely to lead to cardiovascular disease and poor physical fitness (PF), and increase physical activity (PA) and reduce energy intake are the principles of weight control. However, few previous study designing negative energy balance monitoring system to control body weight and observe the cardiovascular performance. OBJECTIVE: This study was to investigate the effects of 12-week different proportion of negative energy balance monitoring interventions on PF and cardiac hemodynamic in young obese women. METHODS: The 53 healthy young obese women (mean age 21.72 ± 1.78; BMI 29.61 ± 3.42) were recruited and randomly assigned to the Calories Restriction Monitor (CRM, 100% diet negative balance), the PA Monitor (PAM, 100% PA negative balance), the Calorie Restriction and PA Monitor (50% CRM + 50% PAM negative balance, CPM) and control group (CG). The CRM, PAM, CPM experimental groups were undergone 12-week intervention with 0.5 kg weight loss per week. The PF and cardiac hemodynamic variables of all the subjects were assessed at week 0 (stage 1), 7 (stage 2) and 13 (stage 3). All the collected data collected were analyzed with Two-Way Mixed ANCOVA, Repeat t test and One-Way ANOVA. RESULTS: 1. Stage and group differences: In stage 3, Weight(W), Body Mass Index(BMI), Fat%, Waist Circumference(WC), Hip Circumference (HC), Endurance Index (EI) of CPM group was significantly better than that of CG. 2. Before and after difference: (1) Body composition: The W, BMI, Fat Free Mass(FFM) and Waist Circumference(WC), HC of CRM, PAM, CPM groups; the Fat% of PAM and CPM groups; and the Waist-Hip Ratio(WHR) of CG and CPM groups all improved significantly after intervention. (2) Physical Ability: The 6-minute walking distance (WD_6min) of CRM, PAM, CPM groups; Long Jump (LJ), EI of CRM and CPM groups; the Curl Ups for 60 seconds (CU60s) of PAM and CPM groups all had improved significantly after intervention. (3) The Cardiac Hemodynamics: The Stroke Volume (SV), Stroke Volume Index (SVI), End Systolic Volume, Left ventricle Ejection Fraction% of PAM group in 1-3 stage; and the SV, SVI of PAM group in 2-3 stage were all improved significantly. 3. Difference volume change (_D)before and after intervention: (1) Body Composition: The W_D, BMI_D, FAT% _D, WC_D, HC_D of CRM, PAM, CPM groups; the Waist-hip Ratio_D (WHR_D) of CPM were all significantly higher than that of CG group. (2) Physical Ability: The CU60s_D of PAM group; the EI_D of CRM, CPM groups; the WD_6min_D of CRM, PAM, CPM groups were all significantly better than that CG group. CONCLUSION: Most of the PF and body composition of 3 experimental groups with different proportion of same negative energy balance were improved after 12-week intervention. However, Only the PAM group had showed the positive effects on cardiac hemodynamic functions, more physical activity may require for better the cardiac dynamic function during weight loss program.