六週太極拳介入對中老年高血壓患者之血壓、踝臂脈波傳導速率及功能性體適能的影響

背景：血壓及踝臂脈波傳導速率 (baPWV) 為心血管臨床測量的重要指標。太極拳訓練能降低健康成年人血壓、減緩動脈硬化，但對已接受藥物治療的中老年高血壓患者是否有加乘效益仍待釐清。目的：探討六週太極拳訓練對已接受藥物治療的中老年高血壓患者其血壓、baPWV 及功能性體適能之影響。方法：招募20名已接受藥物治療之高血壓患者 (年齡：63 ± 6.8歲)，隨機分配至太極組 (TC，n=10) 及對照組 (NE，n=10)，TC進行每週三次各60分鐘太極拳訓練，為期六週；NE則維持無規律運動型態。於第一週 (前測) 及第六週 (後測) 進行血壓、baPWV及功能性體適能量測；另觀察TC在第一次 (F) 及最後一次 (L) 運動前、運動後30及120分鐘的運動後低血壓情形。結果：六週太極拳運動介入後TC之收縮壓後測 (123.3 ± 11.6 mmHg) 顯著低於前測 (132.6 ± 9.6 mmHg) (p < .05)，平均動脈壓後測 (90.9 ± 6.5 mmHg) 亦顯著低於前測 (96.1 ± 7.7 mmHg) (p < .05)；NE則無顯著差異(p > .05)；另外，舒張壓、baPWV與ABI組別及時間因子均無顯著差異 (p > .05)。功能性體適能檢測僅抓背測驗TC後測顯著優於前測，且在後測時顯著優於NE (p < .05)，其餘指標均無顯著差異 (p > .05)。單次運動後收縮壓無交互作用(p > .05)，時間主效果顯著，運動後30及120分鐘皆顯著低於運動前 (p < .05)；舒張壓交互作用顯著 (p < .05)，運動後30分鐘時L顯著低於F (p < .05)。結論：六週太極拳訓練對已接受藥物治療的中老年高血壓者其安靜血壓仍有降壓加乘效益，並改善上肢柔軟度，其餘功能性體適能指標及baPWV則未能改善；單次太極拳運動後低血壓現象持續至運動後120分鐘，且運動後30分鐘時舒張壓的下降幅度大於訓練前。

關鍵字

年長者；心血管疾病；運動訓練；運動後低血壓

並列摘要

Background：Blood pressure and brachial-ankle pulse wave velocity (baPWV) are indicators for cardiovascular disease in clinical setting. Tai Chi has been found reducing blood pressure and arteriosclerosis in healthy adults, but it remains to be clarified whether it has the same effect in middle-aged and elderly hypertensive patients who have received drug treatment. Objective: The purpose of this study was to investigate the effect of six-week Tai Chi exercise on blood pressure, baPWV and functional fitness in middle-aged and elderly hypertensive patients who had taken medication therapy. Methods: Twenty hypertensive patients (age: 63 ± 6.8 yrs) who have received drug treatment were randomized to Tai Chi group (TC, n=10) training for six weeks, three times a week for 60 minutes each, and control group (NE, n=10) maintaining irregular exercise. Blood pressure, baPWV and functional fitness measurements were measured at the first (PRE) and sixth weeks (POST). TC was also observed for post-exercise hypotension acutely at pre-exercise, 30 and 120 minutes after exercise during the first (F) and last (L) training. Results: After six-week Tai Chi intervention, systolic pressure (POST 123.3 ± 11.6 vs. PRE 132.6 ± 9.6 mmHg) and mean arterial pressure (POST 90.9 ± 6.5 vs. PRE 96.1 ± 7.7 mmHg) of TC at POST were significantly lower than at PRE, separately (p < .05). There were no significant differences of NE group (p > .05); In addition, diastolic pressure, baPWV and ABI were not different in treatment or time factor. In the part of functional fitness, only upper limb flexibility of TC at POST were significantly better than at PRE, and TC was significantly better than NE at POST (p < .05), no significant differences were found in other fitness factors (p > .05). As the post-exercise hypotension, systolic blood pressure had no interaction effect (p > .05), but main effect of time was significant. Both 30 and 120 minutes post-exercise were significantly lower than pre-exercise (p < .05). Diastolic blood pressure had interaction effect (p < .05), and L was significantly lower than F at 30 minutes post-exercise (p < .05). Conclusion: Six-week Tai Chi training can lower resting blood pressure and has synergistic effect in middle-aged and elderly hypertensive patients who have received drug treatment. It also improved upper limb flexibility but cannot improve other functional fitness factors and baPWV. In addition, acute hypotension after a single bout of Tai Chi lasted until 120 minutes after exercise and the decrease of diastolic blood pressure at 30 minutes after exercise was greater during L than F.