建議 - 以跨理論模式探討臺灣高齡者從事肌力活動行為與慢性疾病風險之研究

一、給予未來研究方向之建議

(一) 本研究在調查從事肌力活動情形時，僅詢問對象所處的行為改變階段，因此建議未來可以增加類型、強度及頻率等變項，以利針對研究結果及討論的推論。

(二) 本研究的調查為自陳報告，會受到個人主觀感受的影響而研究誤差，因此建議未來研究可以加入客觀的測量來更精確地知道對象從事肌力活動行為的強度、頻率及時間等情形，以便進行更多與肌力活動行為相關的研究。

(三) 由於本研究為橫斷式研究設計，僅能瞭解肌力活動行為與慢性疾病之間的關聯性，不能推斷因果關係，因此建議未來可以設計長期的縱貫性研究來釐清肌力活動行為與高血壓、糖尿病，及心血管疾病之間的因果關係。

二、給予政策執行者之建議

(一) 提升高齡者從事肌力活動行為的比例

本研究結果發現有 58.1%的臺灣高齡者是處在從未考慮從事肌力活動行為的無意圖期，因此建議可以運用跨理論模式中的改變過程來增加處在無意圖期之高齡者對肌力活動行為的認識與瞭解，包括意識覺醒、情緒舒緩及環境再評價，例如藉由媒體宣傳或活動介入，增加對象接觸到與肌力活動行為有關的資訊，亦或是透過相關影片、談話等方式，傳達從事該行為對於社會環境的益處，如有助於增加公共設施的使用率或吸引更多高齡者加入行列等，以加強高齡者對於從事肌力活動行為的意識，並進入到

意圖期。針對處在意圖期的人則可以利用自我再評價的策略，藉由認知與情意的自我形象評估，讓對象瞭解「做」與「不做」肌力活動行為對自己可能會產生哪些影響。對於處在準備期的人則可以運用自我解放，使對象願意許下承諾並從事肌力活動行為。

而對於處在行動期的人則是可以運用反制約、協助關係、增強處理及刺激控制之策略，來順利達到規律從事該行為的維持期。

(二) 關注年齡為 85 歲以上、教育程度較低的高齡者族群

本研究結果發現年齡在 85 歲以上、教育程度較低的高齡者較不容易從事肌力活動行為，因此建議在推動相關介入活動時，

能夠優先為 85 歲以上之高齡者及教育程度較低的族群設計合適的肌力活動計畫，如：藉由課程、講座等活動來提升對於肌力活動行為的認識；教導如何在日常生活中運用身邊的事物或前往運動中心使用相關設備來安全從事肌力活動行為。

(三) 納入高血壓及糖尿病預防之相關衛教宣導

本研究結果發現從事肌力活動行為與高血壓及糖尿病風險有關，因此建議未來在規劃高血壓及糖尿病的預防政策時，除了給予每週從事150 分鐘以上的有氧身體活動之建議外，也應強調每週從事2 次以上的肌力活動行為可能帶來的健康益處，鼓勵高齡者可以試著從事肌力活動行為以維持日常基本功能並促進身體健康。

行政院衛生福利部國民健康署 (2009)。老人健康促進計畫(2009-2012)。

Retrieved from

https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=530&pid=561

Anton, M. M., Cortez-Cooper, M. Y., DeVan, A. E., Neidre, D. B., Cook, J. N.,

& Tanaka, H. (2006). Resistance training increases basal limb blood flow and vascular conductance in aging humans. Journal of Applied

Physiology, 101(5), 1351-1355.

Baechle, T. R., & Westcott, W. L. (2010). Fitness Professional's Guide to

Strength Training Older Adults. Human Kinetics.

Bampton, E. A., Johnson, S. T., & Vallance, J. K. (2016). Correlates and preferences of resistance training among older adults in Alberta, Canada.

Can J Public Health, 107(3), 272-277.

Baumgartner, R. N., Koehler, K. M., Gallagher, D., Romero, L., Heymsfield, S.

B., Ross, R. R., . . . Lindeman, R. D. (1998). Epidemiology of sarcopenia among the elderly in New Mexico. American journal of epidemiology,

147(8), 755-763.

Bopp, M., Wilcox, S., Oberrecht, L., Kammermann, S., & McElmurray, C. T.

(2004). Correlates of strength training in older rural African American and Caucasian women. Women & Health, 40(1), 1-20.

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports, 100(2), 126.

Centers for Disease Control Prevention. (2014). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014.

Atlanta, GA: US Department of Health and Human Services, 2014.

Chan, D.-C. D., Tsou, H.-H., Yang, R.-S., Tsauo, J.-Y., Chen, C.-Y., Hsiung, C.

A., & Kuo, K. N. (2012). A pilot randomized controlled trial to improve geriatric frailty. BMC Geriatrics, 12(1), 1-12.

Chevan, J. (2008). Demographic determinants of participation in strength training activities among US adults. The Journal of Strength &

Conditioning Research, 22(2), 553-558.

Colcombe, S., & Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological science, 14(2), 125-130.

de Camargo Smolarek, A., Ferreira, L. H. B., Mascarenhas, L. P. G., McAnulty, S. R., Varela, K. D., Dangui, M. C., . . . Souza-Junior, T. P. (2016). The effects of strength training on cognitive performance in elderly women.

Clinical interventions in aging, 11, 749.

Dela, F., & Kjaer, M. (2006). Resistance training, insulin sensitivity and muscle

function in the elderly. Essays in biochemistry, 42, 75-88.

Dergance, J. M., Calmbach, W. L., Dhanda, R., Miles, T. P., Hazuda, H. P., &

Mouton, C. P. (2003). Barriers to and benefits of leisure time physical activity in the elderly: differences across cultures. Journal of the

American Geriatrics Society, 51(6), 863-868.

Drenowatz, C., Jakicic, J. M., Blair, S. N., & Hand, G. A. (2015). Differences in correlates of energy balance in normal weight, overweight and obese adults.Obesity research & clinical practice,9(6), 592-602.

Emerson, N. S., Stout, J. R., Fukuda, D. H., Robinson, E. H., Scanlon, T. C., Beyer, K. S., . . . Hoffman, J. R. (2015). Resistance training improves capacity to delay neuromuscular fatigue in older adults. Archives of

gerontology and geriatrics, 61(1), 27-32.

EU Working Group. (2008). EU Physical Activity Guidelines-Recommended Policy Actions in Support of Health-Enhancing Physical Activity:

Brussels.

Fagard, R. H. (2006). Exercise is good for your blood pressure: effects of endurance training and resistance training. Clinical and Experimental

Pharmacology and Physiology, 33(9), 853-856.

Grøntved, A., Rimm, E. B., Willett, W. C., Andersen, L. B., & Hu, F. B. (2012).

A prospective study of weight training and risk of type 2 diabetes mellitus in men.Archives of internal medicine,172(17), 1306-1312.

Gallagher, K. M., Fadel, P. J., Smith, S. A., Norton, K. H., Querry, R. G., Olivencia-Yurvati, A., & Raven, P. B. (2001). Increases in intramuscular pressure raise arterial blood pressure during dynamic exercise. Journal

of Applied Physiology, 91(5), 2351-2358.

Galuska, D. A., Earle, D., & Fulton, J. E. (2002). The epidemiology of US adults who regularly engage in resistance training. Research quarterly

for exercise and sport, 73(3), 330-334.

Hallal, P.C., Gomez, L.F., Parra, D.C., Lobelo, F., Mosquera, J., Florindo, A.A., … et al. (2010). Lessons learned after 10 years of IPAQ use in Brazil and Colombia. Journal of Physical Activity and Health, 7(2), S259–S264.

Harada, K., Oka, K., Shibata, A., Ota, A., Okada, J., & Nakamura, Y. (2008a).

Factors associated with the stages of change for strength training behavior. International Journal of Sport and Health Science, 6, 251-263.

Harada, K., Oka, K., Ota, A., Shibata, A., & Nakamura, Y. (2008b). Prevalence

and correlates of strength training among Japanese adults: analysis of the SSF National Sports-Life Survey 2006. International Journal of Sport

and Health Science, 6, 66-71.

Humphries, B., Duncan, M. J., & Mummery, W. K. (2010). Prevalence and correlates of resistance training in a regional Australian population.

British journal of sports medicine, bjsports48975.

Hunter, G. R., Bryan, D. R., Wetzstein, C. J., Zuckerman, P. A., & Bamman, M.

M. (2002). Resistance training and intra-abdominal adipose tissue in older men and women. Medicine & Science in Sports & Exercise, 34(6), 1023-1028.

Hupin, D., Roche, F., Gremeaux, V., Chatard, J.-C., Oriol, M., Gaspoz, J.-M., . . . Edouard, P. (2015). Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged≥ 60 years: a systematic review and meta-analysis. Br J Sports Med, bjsports-2014-094306.

Karlsdottir, A. E., Foster, C., Porcari, J. P., Palmer-McLean, K., White-Kube, R., & Backes, R. C. (2002). Hemodynamic responses during aerobic and resistance exercise. Journal of cardiopulmonary rehabilitation and

prevention, 22(3), 170-177.

Kaul, K., Tarr, J. M., Ahmad, S. I., Kohner, E. M., & Chibber, R. (2013).

Introduction to diabetes mellitus Diabetes (pp. 1-11): Springer.

Keuerleber, J., & Henschke, N. (2012). Progressive resistance strength training can reduce physical disability in older adults. Br J Sports Med, 46(5), 323-324.

Kim, T. N., Yang, S. J., Yoo, H. J., Lim, K. I., Kang, H. J., Song, W., . . . Baik, S. H. (2009). Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. International Journal of

Obesity, 33(8), 885-892.

Kuwahara, K., Honda, T., Nakagawa, T., Yamamoto, S., Nanri, A., Kurotani, K., ... & Mizoue, T. (2015). Strength training and risk of type 2 diabetes in a Japanese working population: A cohort study. Journal of diabetes investigation, 6(6), 655-661.

Langsetmo, L., Hitchcock, C., Kingwell, E., Davison, K., Berger, C., Forsmo, S., . . . Prior, J. (2012). Physical activity, body mass index and bone mineral density—associations in a prospective population-based cohort of women and men: The Canadian Multicentre Osteoporosis Study (CaMos). Bone, 50(1), 401-408.

Liu, C. j., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. The Cochrane Library.

Lovell, D. I., Cuneo, R., & Gass, G. C. (2009). Resistance training reduces the blood pressure response of older men during submaximum aerobic exercise. Blood pressure monitoring, 14(4), 137-144.

Maslow, A. L., Sui, X., Colabianchi, N., Hussey, J., & Blair, S. N. (2010).

Muscular strength and incident hypertension in normotensive and prehypertensive men. Medicine and science in sports and exercise, 42(2), 288.

Martyn-St James, M., & Carroll, S. (2006). High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporosis

international, 17(8), 1225-1240.

McGuire, A., Seib, C., & Anderson, D. (2016). Factors predicting barriers to exercise in midlife Australian women. Maturitas, 87, 61-66.

Mendis, S., Puska, P., & Norrving, B. (2011). Global atlas on cardiovascular

disease prevention and control: World Health Organization.

Miyachi, M., Kawano, H., Sugawara, J., Takahashi, K., Hayashi, K., Yamazaki, K., ... & Tanaka, H. (2004). Unfavorable effects of resistance training on central arterial compliance: a randomized intervention study. Circulation, 110(18), 2858-2863.

Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., . . . Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation,

116(9), 1094.

O'Donovan, G., Blazevich, A. J., Boreham, C., Cooper, A. R., Crank, H., Ekelund, U., . . . Gill, J. M. (2010). The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. Journal of sports sciences, 28(6), 573-591.

Ogurtsova, K., da Rocha Fernandes, J., Huang, Y., Linnenkamp, U.,

Guariguata, L., Cho, N., . . . Makaroff, L. (2017). IDF Diabetes Atlas:

Global estimates for the prevalence of diabetes for 2015 and 2040.

Diabetes Research and Clinical Practice, 128, 40-50.

Oka, K., & Shibata, A. (2012). Factors associated with the stages of change for dog walking among Japanese dog owners. Journal of Physical

Activity and Health, 10(1), 124-133.

Oliveira, P. F. A., Gadelha, A. B., Gauche, R., Paiva, F. M. L., Bottaro, M., Vianna, L. C., & Lima, R. M. (2015). Resistance training improves isokinetic strength and metabolic syndrome-related phenotypes in postmenopausal women. Clinical interventions in aging, 10, 1299.

Population Reference Bureau. (2017). 2017 WORLD POPULATION DATA SHEET. Retrieved from

http://www.prb.org/pdf17/2017_World_Population.pdf

Rhodes, R. E., Lubans, D. R., Karunamuni, N., Kennedy, S., & Plotnikoff, R.

(2017). Factors associated with participation in resistance training: a systematic review. Br J Sports Med, 51(20), 1466-1472.

Seguin, R., & Nelson, M. E. (2003). The benefits of strength training for older adults. American journal of preventive medicine, 25(3), 141-149.

Shimizu, R., Hotta, K., Yamamoto, S., Matsumoto, T., Kamiya, K., Kato, M., . . . Kamada, Y. (2016). Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy elderly people. European journal of applied

physiology, 116(4), 749-757.

Shiroma, E. J., Cook, N. R., Manson, J. E., Moorthy, M. V., Buring, J. E., Rimm, E. B., & Lee, I. M. (2017). Strength training and the risk of type 2 diabetes and cardiovascular disease.Medicine and science in sports and exercise,49(1), 40.

Socha, M., Frączak, P., Jonak, W., & Sobiech, K. A. (2016). Effect of resistance training with elements of stretching on body composition and quality of life in postmenopausal women. Przeglad menopauzalny= Menopause

review, 15(1), 26.

Straight, C. R., Lindheimer, J. B., Brady, A. O., Dishman, R. K., & Evans, E.

M. (2016). Effects of resistance training on lower-extremity muscle power in middle-aged and older adults: a systematic review and meta-analysis of randomized controlled trials. Sports medicine, 46(3), 353-364.

Surakka, J., Alanen, E., Aunola, S., Karppi, S. L., & Lehto, P. (2004).

Adherence to a power-type strength training programme in sedentary, middle-aged men and women. Advances in Physiotherapy, 6(3), 99-109.

Tanasescu, M., Leitzmann, M. F., Rimm, E. B., Willett, W. C., Stampfer, M. J.,

& Hu, F. B. (2002). Exercise type and intensity in relation to coronary heart disease in men. Jama, 288(16), 1994-2000.

US Department of Health and Human Services. (2008). Physical activity

guidelines advisory committee report. Paper presented at the Washington

(DC): US Department of Health and Human Services.

US Department of Health and Human Services. (2009). Healthy people 2020.

Retrieved from http://www.healthypeople.gov/hp2020/

Vincent, K. R., Braith, R. W., Bottiglieri, T., Vincent, H. K., & Lowenthal, D.

T. (2003). Homocysteine and lipoprotein levels following resistance training in older adults. Preventive cardiology, 6(4), 197-203.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., . . . Jones, D. W. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology.

World Health Organization. (2010). Global recommendations on physical activity for health.

附錄

附錄一、國立臺灣師範大學研究倫理委員會審查核可證明書

附錄二、臺灣高齡者重量訓練與慢性疾病風險之調查問卷

臺灣高齡者重量訓練與慢性疾病風險之調查

先生/小姐，您好：

這裡是_________調查中心，敝姓 __，目前我們接受國立臺灣師 範大學健康促進與衛生教育學系的委託，正在進行關於臺灣高齡者重

請訪員依上方所勾選縣市別，勾選所屬地區

□ (1) 北部地區

□ (2) 中部地區

□ (3) 南部地區

□ (4) 東部及外島地區

S3.性別？（請訪員自行判斷）

□ (1) 男性

□ (2) 女性

□ (12)嘉義市【南部地區】

□ (13)嘉義縣【南部地區】

□ (14)臺南市【南部地區】

□ (15)高雄市【南部地區】

□ (16)屏東縣【南部地區】

□ (17)宜蘭縣【東部地區】

□ (18)花蓮縣【東部地區】

□ (19)臺東縣【東部地區】

□ (20)澎湖縣【外島地區】

□ (21)連江縣【外島地區】

□ (22)金門縣【外島地區】

這部份是關於重量訓練之改變階段調查狀況。

1-1.請依照自己目前的狀況，選擇出最符合的選項?

(1) □ 我目前並沒有從事重量訓練，未來也不打算採取行動。

(2) □ 我目前並沒有從事重量訓練，但打算在未來 6 個月內採取行動。

(3) □ 我目前有從事重量訓練，但並不規律。

（選擇(1) - (3)者，本部分結束）

(4) □ 我目前有規律的從事重量訓練，但未滿 6 個月。

(5) □ 我目前有規律的從事重量訓練，且已維持 6 個月以上。

1-2. 如果有，請問您平均一周從事重量訓練幾次？______次

【此為開放式題項】

第一部分: 重量訓練階段(2 題)

重量訓練(Strength-Training Behavior) 是藉由個人體重所產生的活動阻力，或是於日常生活中的阻力活動，如園藝時的挖土、提貨，或是瑜珈、

太極等；相較於日常生活的習慣活動，會運用到更多肌肉群的活動。

一天______小時_______分鐘

第二部分：身體活動量（6 題）

2-5. 請再次只考慮那些您持續 10 分鐘以上的活動。過去七天內，您有多少天有做中強度的活動？例如：下山健走、用一般速度游泳、下樓梯、跳舞(不含有氧舞蹈、慢舞、國際標準舞或元極舞)、太極（不含外丹功）、用一般速度騎腳踏車、攜帶有點重的東西走路(例如買菜、背、

抱小孩。有點重是指 7.5-15 台斤／4.5-9 公斤：例如二包 A4 的紙、二瓶家庭號鮮奶、一個小玉西瓜、三個帶皮鳳梨、五公斤的米、三個紅磚頭、七瓶玻璃罐的台灣啤酒或米酒、一箱 24 瓶易開罐飲料)、整理庭院

／陽台、費力的家務(清洗窗戶、用手擦地、鋪床、手洗衣服、手工洗車)、或是網球雙打、羽毛球、桌球、排球、棒球？請不要將提輕物的走路算進去。

_______天

□ 沒有做中強度的身體活動請跳答 3-1.

2-6.您通常一天花多少時間，做中強度的身體活動？

一天______小時_______分鐘

3-1.看電視/影帶 DVD _______天 _______小時_______分鐘 3-2.使用電腦/上網（含平板、

滑手機與玩遊戲）

_______天 _______小時_______分鐘

3-3.閱讀書報雜誌 _______天 _______小時_______分鐘 3-4.親友坐著聊天或講電話 _______天 _______小時_______分鐘 3-5.開車/乘坐各種交通工具 _______天 _______小時_______分鐘 3-6.用餐（含三餐、吃點心、

喝茶/飲料）