中高齡者下肢肌力之實證護理--以太極拳訓練介入方案為例

運用太極拳訓練提升下肢肌力，是適合中高齡者的運動方法，亦可藉此降低跌倒機率。本文目的是以實證為基礎，利用文獻回顧的方法提出在改善中高齡者下肢肌力研究中，太極拳訓練應包含的運動訓練方法，做為臨床應用建議之參考。本文將主題以PICO方式呈現，搜尋the Cochrane Library、CINAHL、MEDLINE、Pub Med、華藝線上圖書館、台灣碩博士論文知識加值系統等資料庫，共搜尋到六篇文章，包括統合分析文獻1篇，隨機對照實驗文獻3篇，類實驗性研究2篇，並依Melnyk和Fineout- Overholt之證據分級作為評讀文獻之依據。評析後結果顯示：太極拳運動執行期間，至少持續12週以上、每週至少2次、每次至少50分鐘且須達到中等運動強度，便可見其成效。太極拳招式應簡化，以利於中高齡者執行，並可增加膝與踝屈伸肌之運動及屈膝微蹲架勢之角度，以達強化下肢肌力之效果。在評值肌力時，可透過計時膝屈-伸測試、坐-站測試或等速肌力儀做為檢視成效之依據。太極拳運動在提升中高齡者下肢肌力方面有實質的助益，建議未來可作為提升下肢肌力運動課程之參考，做為中高齡者健身活動的選項之一。

關鍵字

太極拳；中高齡者；下肢肌力

並列摘要

Tai Chi has been regarded as a suitable exercise for the middle-aged and the elderly. It would be helpful in lowering the chances of falling down resulted from weak limbs if it could increase the lower limb's muscle strength. This article aimed to evaluate the effectiveness of tai-chi practices on improving the lower limb's strength of the middle-aged and the elderly through systematic reviews based on empirical-based evidences and serve as future reference. This article presented problems in PICO style. The writer found six articles including one regarding meta-analysis, three regarding randomized experiment and two regarding quasi-experiment from databases namely the Cochrane Library、Evidence-Based Medicine、 Evidence Based Nursing、Pub Med and Airiti library , articles are reviewed based on level of evidence proposed by Melnyk and Fineout-Overholt. Evaluation results show that the middle-aged and elderly practicers of tai chi have their lower limb's muscle strength improved. As a result, the tai chi exercise has been modified and recommended for the middle-aged and the elderly that 1. two 50-minute sections of taichi should be practiced every week for at least 12 weeks, 2. Simplify movements, 3. Increase amount of movements on extensors/ flexors muscle and the angle of knee bending, 4. Evaluate muscle strength based on knee flexion-extension test、chair stand test or inokinetic dynamometer.