本研究是少數探討多面向健身運動對於中年族群睡眠品質影響的研究，研究結果或 可提供中年族群在忙碌的工作與生活中一項改善睡眠品質的可行策略，藉此可能改善其 因睡眠不足所帶來的負面影響。然而本研究仍存在一些限制使得在結果的詮釋上須更為 謹慎。其一，本研究是透過 PSQI 作為評估參與者睡眠品質的測量工具，雖然該量表已 受到許多研究之驗證 (Mollayeva et al., 2016)，然採用量表或問卷等主觀評估方式可能受 到參與者當下的身體狀況、感受以及社會期待所影響，因此所產生出的主觀偏誤較無法 避免；其二，本研究所採用之多面向健身運動包含許多成份，包含心肺適能、肌耐力、
柔軟度、社交互動與冥想等，儘管綜合來看多面向健身運動對於睡眠品質有所助益，但 對於是其中何種面向對於促進睡眠品質有較佳的貢獻較無從比較。故建議未來研究可比 較不同成份之多面向健身運動以確認諸些成份對於睡眠品質的貢獻是否有所差異，以逐 步修正為最有效的多面向健身運動處方 (Takemura et al., 2020)；其三，本研究中的參與 者多數為女性，雖然這可能會導致本研究結果在於男性的解釋力較弱，但該結果亦提供 過去研究不同的觀點。過去研究發現健身運動訓練介入的效益在不同性別中存在差異，
相較於女性，男性可從健身運動中獲得更佳的睡眠相關效益 (Jurado-Fasoli et al., 2020;
Kredlow et al., 2015)。而本研究卻從多數為女性參與者的資料中發現到多面向健身運動 在睡眠品質上的效益，可能解釋了此效益較不受到不同性別在生理上的差異所干擾；其
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四，本研究採用準實驗設計將參與者已非隨機分配至實驗組與控制組，這可能造成兩組 參與者之參數在前測時有其差異存在 (例如：睡眠總分、體重等)，儘管並無統計上的顯 著差異，但前測的差異可能混淆了後續顯著交互作用之結果，故對於此結果的解釋仍須 謹慎並有待於後續研究採隨機對照試驗以及大樣本的實驗設計進行驗證與複製；其五，
由於受到新冠肺炎疫情的影響，本研究實驗組在介入期間多次受到中斷使得介入時間無 法進行連續12周的介入，僅能以間斷性的方式完成12次的運動介入課程，因此在介入效 果上可能受到影響；最後，本研究並無控制參與者在日常生活中的飲食習慣，有鑑於睡 眠品質與身體組成可能受到不同飲食習慣所影響，亦可能干擾參與者於後測時的狀態與 表現，此限制值得後續研究在實驗中加以控制以排除飲食作為干擾變項的可能性。
第陸章 結論與建議
綜合上述，本研究檢驗了多面向健身運動對於中年族群主觀睡眠品質之影響，結 果發現為期12周，每周一次90分鐘的多面向健身運動課程有助於改善中年族群的整體 睡眠品質、睡眠困擾與睡眠效率，除了減少干擾睡眠相關因素與增進效率之外，本研 究之多面向健身運動課程亦同時改善中年族群在肌力與柔軟度相關之健康體適能，以 增進其身體機能保持良好的狀態。此結果意味著。本文就諸些研究結果提出以下幾點 建議：
一、以更為嚴謹的實驗設計檢驗多面向健身運動對睡眠品質之影響：
未來研究可採用更為嚴謹的實驗設計方法，如隨機對照試驗、主動控制組 (其他 睡眠認知行為治療介入)、更多樣本 (如失眠與睡眠呼吸中止症患者) 之研究，除增加 研究內在效度與統計檢定力之外，亦可將研究結果拓展至更多的面向。
二、採用客觀睡眠評估方法：
在研究方法中，本研究所採用的睡眠評估方法為匹茲堡睡眠品質量表。本量表為 主觀的睡眠品質衡量可能受到許多因素所干擾，建議未來研究可採用腦電圖
(electroencephalography, EEG) 來測量個體於睡眠期間的大腦電位活動，以更精準 地評估多面向健身運動對其睡眠品質之影響；此外，亦可進一步搭配加速規身體活動
量紀錄器 (accelerometer)，配戴裝置可以客觀的測量參與者入睡時間，睡眠時間，
睡眠效率等數值，以獲取更為準確的睡眠指標以檢驗實驗介入的有效性。
三、探討急性多面向健身運動訓練對於睡眠品質之影響：
過去已發現一次性的有氧或阻力健身運動對於個體的生理、心理與認知等面向的 結果與表現有其急性正向效果，然目前較少研究探討多面向健身運動的急性效果，有 鑑於本研究以初步發現長期多面向健身運動對於主觀睡眠品質之影響，未來研究或可 朝向探討急性多面向健身運動對睡眠品質之影響，可用以釐清多面向健身運動從短期 至長期效益之變化。
四、設計最佳促進睡眠品質之多面向健身運動處方：
考量到參與者的時間限制，實驗介入的頻率採每周一次，每次時間為 90 分鐘的多 面向健身運動課程。依照 2018 美國運動醫學會指引方針所提出的最新標準，建議成年 人每周要進行 150 至 300 分鐘的中等強度健身運動，以及建議除了每周一次的 90 分鐘 的團體課程，可加入每周兩次九十分鐘的自我練習或線上課程。雖然本研究發現 90 分 鐘即對睡眠品質有正向影響，但未來研究亦可採用不同課程時間劑量進行比較，以確 認對睡眠品質較佳的多面向健身運動處方。
五、多面向健身運動對睡眠品質影響之潛在機制：
透過本研究結果可以發現多面向健身運動對於睡眠品質與健康體適能有所助益，
然尚無法得知其中的效益是從何而來，故探討當中的潛在影響因子亦能使未來研究更 瞭解多面向健身運動透過何種機制影響睡眠品質。本研究之多面向健身運動是以八卦 導引為基礎，包含了慢跑、伸展、肌力、冥想及社交活動並透過各種延伸與擰轉動作 來放鬆和鍛煉參與者的身體各部位是該課程的一大特色，例如上班族長期使用電腦導 致長期肩頸手腕痠痛，可運用第一式的猛虎出山動作來伸展上肢，第二式大鵬展翅及 第八式青龍探爪來做上肢的擰轉，第四式白猿獻果來做後背之延展的動作來放鬆及鍛 鍊上肢。此過程可能涉及個體的協調、柔軟度與肌力等因素，因此未來研究或可探討 是何種因素的提升在於多面向健身運動與睡眠品質之間佔有較大的貢獻程度，以釐清
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