(一)高齡者其每週身體活動量較高者踝臂指數也較健康,而太長的坐姿時間也是一項危 險因子,因此建議高齡者多從事規律且漸進輕度到中高強度的身體活動,維持每週身體 活動量,將有助於幫助周邊血管之健康並減少靜態坐式生活方式。
(二)建議高齡者增加從事心肺適能之有氧運動,維持自我有氧代謝能力,將有助於增進 血液循環,增進肌肉組織血流量。運動介入的時間從三個月到半年或一年,有氧運動訓 練已被證實能顯著改善患肢最大充血時的小腿血流量。
(三)踝臂指數亦可當作一項預測高齡者血管下肢肌肉之氧化功能健康指數。
(四)未來研究方向,可增加不同踝臂指數之受試者人數或探討不同年齡層及性別對象。
(五)未來利用運動介入式研究,探討運動訓練對 ABI 和下肢肌肉氧合能力之影響,運甕 方式可考量有氧運動或阻力運動。
參考文獻
一、 中文部分
行政院內政部統計處(2012)。2012 主要死因死亡人數及死亡率。統計年鑑,取自網站:
http://www.dgbas.gov.tw
趙婉茹、吳英黛、劉千綺 (2010)。 運動訓練對周邊動脈疾病患者周邊循環之療效:
系統回顧與統合分析。 物理治療,35(1),38-50。
陳美如、蔡世傑、陳宣志 (2006)。周邊動脈阻塞疾病。基層醫學,21(11) ,318-325。
宣錦峰(2008)。淺談周邊動脈。義大醫訊,26(4),45-46。
林盈利、蘇育德、林益卿(2010)。周邊動脈疾病。家庭醫學與基層醫療,25(5) ,188-195。
李佳倫、鄭景峰 (2010)。臺灣老年人身體活動量與功能性體適能的關係。 大專體育 學刊, 12(4), 79-89。
二、 英文部分
Allison, M. A., Hiatt, W. R., Hirsch, A. T., Coll, J. R., & Criqui, M. H. (2008). A high
ankle-brachial index is associated with increased cardiovascular disease morbidity and lower quality of life. J Am Coll Cardiol, 51(13), 1292-1298.
Allison, M. A., Ho, E., Denenberg, J. O., Langer, R. D., Newman, A. B., Fabsitz, R. R., &
Criqui, M. H. (2007). Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med, 32(4), 328-333.
Anderson, J. D., Epstein, F. H., Meyer, C. H., Hagspiel, K. D., Wang, H., Berr, S. S., . . . Kramer, C. M. (2009). Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism. Journal of the American College of Cardiology, 54(7), 628-635.
Bauer, T. A., Brass, E. P., Barstow, T. J., & Hiatt, W. R. (2007). Skeletal muscle StO2 kinetics are slowed during low work rate calf exercise in peripheral arterial disease. European Journal of Applied Physiology 100(2), 143-151.
Bauer, T. A., Brass, E. P., & Hiatt, W. R. (2004a). Impaired muscle oxygen use at onset of exercise in peripheral arterial disease. Journal of Vascular Surgery 40(3), 488-493.
Brass, Eric P., Hiatt, William R., & Green, Simon. (2004). Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point — counterpoint discussion. Vascular Medicine, 9(4), 293-301.
Collins, Langbein, W. E., Orebaugh, C., Bammert, C. , Hanson, K. , Domenic, . . . Littooy, F.
N. (2005). Cardiovascular Training Effect Associated With Polestriding Exercise in Patients With Peripheral Arterial Disease Journal of Cardiovascular Nursing, 20(3), 177-185.
Collins, Lunos, S., & Ahluwalia, J. S. (2010). Self-efficacy is associated with walking ability in persons with diabetes mellitus and peripheral arterial disease. Vasc Med, 15(3), 189-195.
Collins, McBurney, C., Butler, J., Jelinek, C., O'Connell, S., Fritschi, C., & Reda, D. (2012).
The Effects of Walking or Walking-with-Poles Training on Tissue Oxygenation in Patients with Peripheral Arterial Disease. International Journal of Vascular Medicine,
2012(985025), 1-8.
David, C. , Lyndon, J. O., Mary, C., Andrew, W., & Leslie, I. (2001). Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheralarterialdisease.
The American Journal of Cardiology 87, 324-329.
Enright, P. L. (2003). The Six-Minute Walk Test. RESPIRATORY CARE, 48(8), 783-785.
Fowkes, F. G. (2008). Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality -a meta-analysis. The Jourmal of the American Medical Association, 300(3), 197-208.
Guyatt, G. H., Sullivan, M. J., Thompson, P. J., Fallen, E. L., Pugsley, S. O., Taylor, D. W., &
Berman, L. B. (1985). The 6 minute walk a new measure of exercise capacity in patients with chronic heart failure. Canadian Medical Association Journal, 132(15), 919-923.
Hamburg, N. M., & Balady, G. J. (2011). Exercise rehabilitation in peripheral artery disease:
functional impact and mechanisms of benefits. Circulation, 123(1), 87-97.
Hawkins, S. A., & Wiswell, R. A. (2003). Rate and mechanism of maximal oxygen consumption decline with aging. Sports medicine, 33(12), 877-888.
Hiatt, W. R. (2001). Medical Treatment of Peripheral Arterial Disease and Claudication. New England Journal of Medicine, 344(21), 1608-1621.
Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., . . . Riegel, B. (2006). ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation.
Circulation, 113(11), e463-e654.
Ingle, L., Rigby, A. S., Carroll, S., Butterly, R., King, R. F., Cooke, C. B., . . . Clark, A. L.
(2007). Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure. European Heart Journal, 28(5), 560-568.
Kervio, G., Carre, F., & Ville, N. S. (2003). Reliability and intensity of the six-minute walk test in healthy elderly subjects. Med Sci Sports Exerc, 35(1), 169-174.
Komiyama, T., Shigematsu, H., Yasuhara, H., & Muto, T. (2000). NIRS grades the severity of intermittent claudication in diabetics more accurately than ankle pressure
measurement. British Journal of Surgery, 87, 459-466.
Kooijman, H. M., Hopman, M. T. E. , Willy N. J. M. Colier, J. Adam van der Vliet, &
Oeseburg, B. (1997). Near Infrared Spectroscopy for Noninvasive Assessment of Claudication. JOURNAL OF SURGICAL RESEARCH, 72, 1-7.
Le Faucheur, A., Abraham, P., Jaquinandi, V., Bouye, P., Saumet, J. L., & Noury-Desvaux, B.
(2008). Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation, 117(7),
897-904.
Lipkin, D. P., Scriven, A. J., Ceake, T. , & Wilson, P. A. (1986). Six minute walking test for assessing exercise capacity chronic heart failure. BRITISH MEDICAL JOURNAL, 292(8).
Malagoni, A. M., Felisatti, M., Mandini, S., Mascoli, F., Manfredini, R., Basaglia, N., . . . Manfredini, F. (2010). Resting muscle oxygen consumption by near-infrared
spectroscopy in peripheral arterial disease: A parameter to be considered in a clinical setting? Angiology, 61(6), 530-536.
McDermott, Criqui, M. H., Ferrucci, L., Guralnik, J. M., Tian, L., Liu, K., . . . Pearce, W. H.
(2006). Obesity, weight change, and functional decline in peripheral arterial disease. J Vasc Surg, 43(6), 1198-1204.
McDermott, Ferrucci, L., Guralnik, J. M., Dyer, A. R., Liu, K., Pearce, W. H., . . . Criqui, M.
H. (2010). The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease. Vasc Med, 15(4), 251-257.
McDermott, Greenland, P., Liu, K., Guralnik, J. M. , Celic, L. , Criqui, M. H., . . . Clark, A.
L. (2002). The ankle brachial index is associated with leg function and physical activity : the walking and leg circulation study. Annals of Internal Medicine, 136, 873-883.
McDermott, Liu, K., Criqui, M. H., Ruth, K., Goff, D., Saad, M. F., . . . Sharrett, A. R. (2005).
Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis. Am J Epidemiol, 162(1), 33-41.
Mohler, E. R., 3rd, Lech, G., Supple, G. E., Wang, H., & Chance, B. (2006). Impaired exercise-induced blood volume in type 2 diabetes with or without peripheral arterial disease measured by continuous-wave near-infrared spectroscopy. Diabetes Care, 29(8), 1856-1859.
Montgomery, P. S., & Gardner, A. W. (1998). The Clinical Utility of a Six-Minute Walk Test in Peripheral Arterial Occlusive Disease Patients. Journal of the American Geriatrics Society, 46(6), 706-711.
Mossberg, K. A. , & Fortini, E. (2012). Responsiveness and Validity of the Six-Minute Walk Test in Individuals With Traumatic Brain Injury. Physical Therapy, 92(5), 726-733.
Parr, B. , Noakes, T. D. , & Derman, E. W. . (2008). Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication. South African Medical Journal, 98, 958-962.
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., . . . Turner, M. B. (2012). Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation, 125(1), e2-e220.
Saxton, J. M., Zwierska, I., Blagojevic, M., Choksy, S. A., Nawaz, S., & Pockley, A. G.
(2011). Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. Journal of Vascular Surgery 53(5), 1265-1273.
Schroder, F., Diehm, N., Kareem, S., Ames, M., Pira, A., Zwettler, U., . . . Diehm, C. (2006).
A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. Journal of Vascular Surgery 44(3), 531-536.
Tegos, T. J., Kalodiki, E., Sabetai, M. M., & Nicolaides, A. N. (2001). The Genesis of Atherosclerosis and Risk Factors : A Review. Angiology, 52(2), 89-98.
Yamamoto, K., Miyata, T., Onozuka, A., Koyama, H., Ohtsu, H., & Nagawa, H. (2007).
Plantar flexion as an alternative to treadmill exercise for evaluating patients with intermittent claudication. European Journal of Vascular and Endovascular Surgery 33(3), 325-329.
Yan, B. P., Lau, J. Y., Yu, C. M., Au, K., Chan, K. W., Yu, D. S., . . . Hiatt, W. R. (2011).
Chinese translation and validation of the Walking Impairment Questionnaire in patients with peripheral artery disease. Vasc Med, 16(3), 167-172.
附錄一 參與者知情同意書
5.實驗流程:
6.可能產生之副作用、危險及處理方法
因本研究針對老年人進行心肺功能檢測(六分鐘跑走測驗),屬於非最大運動能力測 驗,強度不高,檢測過程中受試者若有不適,則立即停止測驗。
7.聲明
受試者聲明:我已了解以上的資訊且同意參與此項研究計畫。
受試者姓名(正楷) 簽名 _______日期 ____________
研究者聲明:
我本人或我研究團隊中的一位成員(已獲授權進行本步驟的代表),已對上述人 士解釋過本研究,包括本研究的目的、方法與參加本研究可能的相關危險性和效 益。受試者所提出之疑問,均已予以答覆。
解釋同意書之研究人員(正楷) 簽名 _______日期
________附錄二 IPAQ 台灣活動量調查問卷
IPAQ 台灣活動量調查 短版問卷
問卷版本:2013.02.27 受試者編號:__________
行政院衛生署國民健康局
研究單位: 國立臺灣師範大學體育系碩士班 研究生:周宛嬋 指導教授:方進隆 教授 碩士論文_老年男性不同踝臂指數與下肢肌肉氧合能力及心肺適能之研究
身體活動量問卷
您的回答將有助於我們了解您的身體活動的現況。
想請教您的是:有關您在 過去七天 中花在身體活動的時間,包括工作、做 家事、整理庭院/陽台、交通,及您在娛樂、運動等活動中所花的時間。
就算您認為自己不愛動,也請您回答每一個問題。
您過去七天的身體活動與過去 3 個月的身體活動比較起來(請打勾)
□1.比較多 □2.比較少 □3.差不多(請繼續)
費力活動 :持續從事 10 分鐘以上身體活動時,會讓你無法一面活動,一 面跟別人輕鬆說話,這些活動會讓您的身體感覺很累,呼吸比平常快很多,
流很多汗,心跳加快很多。
請回想過去七天中,所有您做過的 費力 活動。這些活動會讓您的身體感覺 費力,呼吸比平常喘很多,但請只考慮那些一次您至少會持續 10 分鐘以上 的身體活動。
1、過去七天中,您有多少天有做 費力 的身體活動?例如跑步、上山爬坡、
持續性的快速游泳(不含慢游、玩水、泡水)、上樓梯、有氧舞蹈/運動、快 速地騎腳踏車、打球(如網球單打、籃球、足球)、跳繩、重量訓練、搬運重 物(大於 17 台斤/10 公斤)、或者是鏟土。
_______天
□ 沒有做費力的身體活動 請跳答問題 3
2、您通常一天花多少時間在費力的身體活動上?
一天______小時_______分鐘
中等費力活動 :持續從事 10 分鐘以上身體活動時,還可以舒服的對話,
但無法唱歌,這些活動會讓您覺得有點累,呼吸比平常快一些,流一些汗,
心跳快一些。例如:健走、下山、一般速度游泳、網球雙打、羽毛球、桌 球、排球、太極拳、跳舞(不包括有氧舞蹈、慢舞、國標舞、元極舞) 、一 般速度騎腳踏車等。
回想過去七天中,您所有做過 中等費力 的活動。中等費力的活動表示:這 些活動會讓您覺得身體有點費力,呼吸比平常喘些,但請只考慮那些您一 次至少持續 10 分鐘以上的身體活動。
3、過去七天中,您有多少天有做中等費力的活動?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
□ 沒有做中等費力的活動 請跳答問題 5
4、您通常一天花多少時間在中等費力的活動上?
一天______小時_______分鐘
□ 不知道/不確定
回想過去七天中,您花在 走路 上的時間有多久?包括工作、居家、和外出 交通時的走路,以及您純粹為了娛樂、運動及休閒而花在走路(不含上下 樓梯、爬山)上的時間。
5、過去七天中,您有多少天曾經走路持續 10 分鐘以上?
_______天
□ 沒有走路持續 10 分鐘以上 請跳答問題 7
6、您通常一天花在走路上的時間有多久?
一天______小時_______分鐘
□ 不知道/不確定
最後一個問題是:過去七天的工作天中,您坐著的時間有多久?請將工作、
居家、做功課及休閒的時間都算進去,包括坐在桌前、打電腦、拜訪朋友、
吃飯、閱讀、坐著或斜躺著看電視,但請不要將睡著的時間算進去。
_____________________________________________________________________