比較時間增長型及強度增強型運動訓練計劃對心臟衰竭病患之成效

Comparison of effectiveness between duration-increased exercise training and intensity-increased exercise training among patients with heart failure

施淑娟(Shu-Chuan Shih)

指導教授 ： 鄭 綺

臺北醫學大學/護理學院/護理學研究所/碩士(2002年)

摘要

心臟衰竭已經成為現代健康中重要的問題之一，其發展迅速且為老年人住院的主要因素之一，而藥物治療並無法完全改善其罹患率及死亡率，因此強調以非藥物性治療來改善其身體功能及不適之症狀，其中適當的運動即為專家學者所倡導。但是不同的運動訓練計劃，則有不同的成效，因此本研究目的有二：（一）比較時間增長型及強度增強型運動訓練計劃對心臟衰竭病患尖峰耗氧量、最大工作負荷量、生活品質、日常活動自我效能、疲憊及呼吸困難的影響；(二)探討兩種不同運動訓練計劃運動成效之預測變項。 本研究以立意取樣法(purposive sampling)選取台北市某兩家教學醫院，符合選樣條件者共21位全程參與運動訓練計劃，其中10位參與時間增長型運動訓練計劃，11位參與強度增強型運動訓練計劃，採運動測試及問卷兩種方式進行資料收集。資料分析採用平均值、標準差、百分比、卡方檢定、Mann-Whitney test、Wilcoxon Signed Ranks Test、Spearmen’s correlation、Multiple regression等統計方法。 本研究結果顯示：(一)時間增長型及強度增強型運動訓練計劃皆能有效改善心臟衰竭患者之尖峰耗氧量、最大工作負荷量、生活品質、日常活動自我效能、疲憊及呼吸困難。(二)兩組運動訓練成效之比較除強度增強組在最大工作負荷量顯著高於時間增長組外，其他變項皆未達統計上之顯著差異。(三)組別是最大工作負荷量進步的主要預測變項，解釋量達15%；組別與性別則是生活品質提升的主要預測變項，解釋量達55%；而日常活動自我效能增進之主要預測變項為教育程度，其解釋量達43%。 本研究結果可提供護理人員在給予心臟衰竭患者設計運動處方時之參考，以提升心臟衰竭照護之品質並提昇護理人員之專業角色。

關鍵字

心臟衰竭 ； 運動測試 ； 尖峰耗氧量 ； 最大工作負荷量 ； 生活品質 ； 日常活動自我效能 ； 疲憊 ； 呼吸困難

並列摘要

HF（heart failure）had been one of the important health problems and is a major reason for hospitalization in elderly patients. Non-pharmacotherapy has been used to improve a HF patient’s physical function and discomfort symptoms. Although regular exercise id considered as a good treatment for HF patients, the outcomes based on various exercises training protocols are different. The purpose of this study were to :（1）compare the exercise outcomes in terms of peak oxygen consumption（peak VO2）, maximal workload, quality of life（QOL）, self-efficacy of daily activities, fatigue, and dyspnea between the duration- and intensity-increased exercise training programs.（2）explore the predictors of exercise outcomes for these two kinds of exercise training programs. Twenty-one subjects who met the selection criteria were selected by a purposive sampling method from two teaching hospitals in Taipei. Subjects were assigned into either a duration-increased exercise training group（n=10）or an intensity-increased exercise training group（n=11）. Both exercise-training programs were three times per week for 8 weeks. Data was collected by means of exercise testing and questionnaires. Data was analysis by using chi-square, Mann-Whitney test, Wilcoxon Signed Ranks test, Spearmen’s correlation, and Multiple regression. The results of this study revealed were a significant improvement in peak VO2 , maximal workload, QOL, self-efficacy of daily activities, fatigue, and dyspnea were observed for both exercise training programs. Except the maximal workload, the improvement peak VO2 , QOL, self-efficacy of daily activities, fatigue, and dyspnea for the intensity-increased group did not significantly differ from the duration-increased group. A different group was a major predictor for the improvement in maximal workload and explained 15% of the variance in improvements of maximal workload. Both group and sex were significant predictors for the improvement in QOL and explained 55% of the variance in improvements of QOL. An educational level was a major predictor for the improvement in self-efficacy of daily activities and explained 43% of the variance in improvements of self-efficacy of daily activities. The result of this study suggested that both exercise-training programs are helpful and can be used to improve the quality of care for HF patients.

並列關鍵字

heart failure ； exercise testing ； peak VO2 ； maximal workload ； quality of life ； self-efficacy of daily activity ； fatigue ； dyspnea

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