• 沒有找到結果。

本研究參與者整體生理指標同質性高,在相類似的背景基礎下,實驗組在提升身體 活動量後,整體心血管功能 (血壓、自律神經) 較控制組有顯著改善,表示四週的提升 身體活動量對身體的生理功能是有幫助的。更進一步得知,實驗組的血壓於介入的第二 週就有顯著下降,且自律神經功能於介入的第三週有顯著改善,不同於以往的研究僅注 重前測與後測間的差異,而忽略了介入期間的改變。雖然實驗組的 PSQI 睡眠品質分數 有下降但並未達顯著差異,我們所推論的可能原因包括:介入的時間太短,能夠改善的

46

睡眠品質有限以及更年期症候群婦女容易因生理功能的變化而引起心理壓力,導致睡眠 品質不佳。但實驗組 ESS 嗜睡量表的分數於介入的第一週就有顯著下降,表示白天的精 神狀況變好,不易打瞌睡。

身體活動量的介入對於心率變異性具有正向影響,最重要的是在介入後,早上與晚 上的心率變異性差異變大,表示身體狀況較佳,當外在環境改變時,自律神經能夠快速 且有效的調控身體,做出即時反應。

本研究針對潛在高血壓的更年期婦女合併睡眠問題做為研究對象,有這樣問題之婦 女不在少數,也藉此鼓勵有同樣問題的女性在整體生理功能未嚴重退化前,盡早養成運 動習慣或提升身體活動量來降低老化時所帶來之生理功能之影響。

二、建議

(一) 由於整個收案過程從前測、四週身體活動量介入及後測僅有四週的時間,對於四週 後心血管功能及睡眠品質的後續影響會是如何無法做更多的探討,以後研究可以在身體 活動量介入結束後,繼續收集參與者之生理參數,以便了解運動對於心血管功能的保護 效果能夠持續多長的時間。

(二) 本研究提升身體活動量的介入並未能量化其身體活動量,僅要求參與者每週至少三 次以上、每次至少三十分鐘的額外身體活動量,並以運動日誌做紀錄,所以無法得知身 體活動量增加多少有助於改善心血管功能,建議以後的研究可以使用儀器記錄身體活動 量,以量化其標準,做為以後建議想要改善心血管功能的人之指標。

47

Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science, 213(4504), 220-222.

Amano, M., Kanda, T., Ue, H., & Moritani, T. (2001). Exercise training and autonomic nervous system activity in obese individuals. Medicine and Science in Sports and Exercise, 33(8), 1287-1291.

Barnabei, V. M., Grady, D., Stovall, D. W., Cauley, J. A., Lin, F., Stuenkel, C. A., . . . Pickar, J.

H. (2002). Menopausal symptoms in older women and the effects of treatment with hormone therapy. Obstetrics and Gynecology, 100(6), 1209-1218.

Brunner, R. L., Aragaki, A., Barnabei, V., Cochrane, B. B., Gass, M., Hendrix, S., . . . Stefanick, M. (2010). Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial.

Menopause, 17(5), 946-954. doi: 10.1097/gme.0b013e3181d76953

Cannarella, R., & Agbayani, E. (2001). Tetanus: a case report, epidemiology review and

recommendations for immunization compliance. West Virginia Medical Journal, 97(5), 253-256.

Cappuccio, F. P., Stranges, S., Kandala, N. B., Miller, M. A., Taggart, F. M., Kumari, M., . . . Marmot, M. G. (2007). Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. Hypertension, 50(4), 693-700. doi: 10.1161/HYPERTENSIONAHA.107.095471

Carter, J. B., Banister, E. W., & Blaber, A. P. (2003). Effect of endurance exercise on autonomic control of heart rate. Sports medicine, 33(1), 33-46.

Collier, S. R., Kanaley, J. A., Carhart, R., Jr., Frechette, V., Tobin, M. M., Bennett, N., . . . Fernhall, B. (2009). Cardiac autonomic function and baroreflex changes following 4 weeks of resistance versus aerobic training in individuals with pre-hypertension.

48

Acta Physiologica (Oxf), 195(3), 339-348. doi: 10.1111/j.1748-1716.2008.01897.x Coylewright, M., Reckelhoff, J. F., & Ouyang, P. (2008). Menopause and hypertension: an

age-old debate. Hypertension, 51(4), 952-959. doi:

10.1161/HYPERTENSIONAHA.107.105742

Dengel, D. R., Hagberg, J. M., Pratley, R. E., Rogus, E. M., & Goldberg, A. P. (1998).

Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men.

Metabolism, 47(9), 1075-1082.

Driver, H. S., & Taylor, S. R. (2000). Exercise and sleep. Sleep Medicine Reviews , 4(4), 387-402. doi: 10.1053/smrv.2000.0110

Eichling, P. S., & Sahni, J. (2005). Menopause related sleep disorders. Journal of Clinical Sleep Medicine, 1(3), 291-300.

Ekblom, B., Kilbom, A., & Soltysiak, J. (1973). Physical training, bradycardia, and autonomic nervous system. Scandinavian Journal of Clinical and Laboratory Investigation, 32(3), 251-256.

Fensli, R., Gunnarson, E., & Hejlesen, O. (2004). A wireless ECG system for continuous event recording and communication to a clinical alarm station. Conference of the IEEE Engineering in Medicine & Biology Society, 3, 2208-2211. doi:

10.1109/IEMBS.2004.1403644

Flausino, N. H., Da Silva Prado, J. M., de Queiroz, S. S., Tufik, S., & de Mello, M. T. (2012).

Physical exercise performed before bedtime improves the sleep pattern of healthy young good sleepers. Psychophysiology, 49(2), 186-192. doi:

10.1111/j.1469-8986.2011.01300.x

Fletcher, G. F., Blair, S. N., Blumenthal, J., Caspersen, C., Chaitman, B., Epstein, S., . . . Pina, I. L. (1992). Statement on exercise. Benefits and recommendations for physical

activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation, 86(1), 340-344.

Gangwisch, J. E. (2014). A review of evidence for the link between sleep duration and hypertension. American Journal of Hypertension , 27(10), 1235-1242. doi:

10.1093/ajh/hpu071

Green, D. J., O'Driscoll, G., Joyner, M. J., & Cable, N. T. (2008). Exercise and cardiovascular risk reduction: time to update the rationale for exercise? Journal of Applied

Physiology (1985), 105(2), 766-768. doi: 10.1152/japplphysiol.01028.2007

Guzzetti, S., La Rovere, M. T., Pinna, G. D., Maestri, R., Borroni, E., Porta, A., . . . Malliani,

49

A. (2005). Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure. European Heart Journal, 26(4), 357-362. doi: 10.1093/eurheartj/ehi067

Hagberg, J. M., Park, J. J., & Brown, M. D. (2000). The role of exercise training in the treatment of hypertension: an update. Sports Medicine, 30(3), 193-206.

Hall, M., Vasko, R., Buysse, D., Ombao, H., Chen, Q., Cashmere, J. D., . . . Thayer, J. F.

(2004). Acute stress affects heart rate variability during sleep. Psychosomatic Medicine, 66(1), 56-62.

Heart rate variability: standards of measurement, physiological interpretation and clinical use.

Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Circulation, 93(5), 1043-1065.

Hoikkala, H., Haapalahti, P., Viitasalo, M., Vaananen, H., Sovijarvi, A. R., Ylikorkala, O., &

Mikkola, T. S. (2010). Association between vasomotor hot flashes and heart rate variability in recently postmenopausal women. Menopause, 17(2), 315-320. doi:

10.1097/gme.0b013e3181c2bb6d

Huang, W. T., Chen, C. H., Chang, Y. J., Chen, Y. Y., Huang, J. L., Yang, C. M., & Yang, T. L.

(2008). Exquisite textiles sensors and wireless sensor network device for home health care. Conference of the IEEE Engineering in Medicine & Biology Society, 2008, 546-549. doi: 10.1109/IEMBS.2008.4649211

Huston, T. P., Puffer, J. C., & Rodney, W. M. (1985). The athletic heart syndrome. The New England Journal of Medicine , 313(1), 24-32. doi: 10.1056/NEJM198507043130106 Imeri, L., & Opp, M. R. (2009). How (and why) the immune system makes us sleep. Nature

Reviews Neuroscience , 10(3), 199-210. doi: 10.1038/nrn2576

Joffe, H., Massler, A., & Sharkey, K. M. (2010). Evaluation and management of sleep disturbance during the menopause transition. Seminars in Reproductive Medicine , 28(5), 404-421. doi: 10.1055/s-0030-1262900

Jovanov, E., Milenkovic, A., Otto, C., & de Groen, P. C. (2005). A wireless body area network of intelligent motion sensors for computer assisted physical rehabilitation. Journal of NeuroEngineering & Rehabilitation, 2(1), 6. doi: 10.1186/1743-0003-2-6

Julius, S. (1991). Autonomic nervous system dysregulation in human hypertension. American Journal of Cardiology, 67(10), 3B-7B.

Kamel, N. S., & Gammack, J. K. (2006). Insomnia in the elderly: cause, approach, and treatment. American Journal of Medicine, 119(6), 463-469. doi:

10.1016/j.amjmed.2005.10.051

King, A. C., Oman, R. F., Brassington, G. S., Bliwise, D. L., & Haskell, W. L. (1997).

50

Moderate-intensity exercise and self-rated quality of sleep in older adults. A

randomized controlled trial. Journal of the American Medical Association , 277(1), 32-37.

King, A. C., Pruitt, L. A., Woo, S., Castro, C. M., Ahn, D. K., Vitiello, M. V., . . . Bliwise, D.

L. (2008). Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 63(9), 997-1004.

Kuo, T. B., Shaw, F. Z., Lai, C. J., Lai, C. W., & Yang, C. C. (2004). Changes in sleep patterns in spontaneously hypertensive rats. Sleep, 27(3), 406-412.

Lee, J. O., Kang, S. G., Kim, S. H., Park, S. J., & Song, S. W. (2011). The Relationship between Menopausal Symptoms and Heart Rate Variability in Middle Aged Women.

Korean Journal of Family Medicine, 32(5), 299-305. doi: 10.4082/kjfm.2011.32.5.299 Padilla, J., Wallace, J. P., & Park, S. (2005). Accumulation of physical activity reduces blood

pressure in pre- and hypertension. Medicine & Science in Sports and Exercise, 37(8), 1264-1275.

Parry, B. L. (2007). Sleep disturbances at menopause are related to sleep disorders and

anxiety symptoms. Menopause, 14(5), 812-814. doi: 10.1097/gme.0b013e318127188b Player, M. S., King, D. E., Mainous, A. G., 3rd, & Geesey, M. E. (2007). Psychosocial factors

and progression from prehypertension to hypertension or coronary heart disease.

Annals of Family Medicine, 5(5), 403-411. doi: 10.1370/afm.738

Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine , 11(9), 934-940. doi: 10.1016/j.sleep.2010.04.014

Sawka, M. N., Convertino, V. A., Eichner, E. R., Schnieder, S. M., & Young, A. J. (2000).

Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness. Medicine & Science in Sports and Exercise, 32(2), 332-348.

Schultz, M. G., Otahal, P., Cleland, V. J., Blizzard, L., Marwick, T. H., & Sharman, J. E.

(2013). Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis.

American Journal of Hypertension , 26(3), 357-366. doi: 10.1093/ajh/hps053

Soares, C. N., Arsenio, H., Joffe, H., Bankier, B., Cassano, P., Petrillo, L. F., & Cohen, L. S.

(2006). Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life. Menopause, 13(5), 780-786. doi:

10.1097/01.gme.0000240633.46300.fa

51

Tamura, T., Mizukura, I., Sekine, M., & Kimura, Y. (2011). Monitoring and evaluation of blood pressure changes with a home healthcare system. The IEEE Transactions on Information Technology in Biomedicine, 15(4), 602-607. doi:

10.1109/TITB.2011.2156804

Thurston, R. C., Blumenthal, J. A., Babyak, M. A., & Sherwood, A. (2006). Association between hot flashes, sleep complaints, and psychological functioning among healthy menopausal women. International Journal of Behavioral Medicine, 13(2), 163-172.

doi: 10.1207/s15327558ijbm1302_8

Tulppo, M. P., Makikallio, T. H., Seppanen, T., Laukkanen, R. T., & Huikuri, H. V. (1998).

Vagal modulation of heart rate during exercise: effects of age and physical fitness.

American Journal of Physiology , 274(2 Pt 2), H424-429.

Vgontzas, A. N., Liao, D., Bixler, E. O., Chrousos, G. P., & Vela-Bueno, A. (2009). Insomnia with objective short sleep duration is associated with a high risk for hypertension.

Sleep, 32(4), 491-497.

Vogel, G. W., Buffenstein, A., Minter, K., & Hennessey, A. (1990). Drug effects on REM sleep and on endogenous depression. Neuroscience & Biobehavioral Reviews , 14(1), 49-63.

Wallace, J. P. (2003). Exercise in hypertension. A clinical review. Sports Medicine, 33(8), 585-598.

Yanagimoto, S., Kuwahara, T., Zhang, Y., Koga, S., Inoue, Y., & Kondo, N. (2003).

Intensity-dependent thermoregulatory responses at the onset of dynamic exercise in mildly heated humans. American Journal of Physiology: Regulatory, Integrative and Comparative Physiology , 285(1), R200-207. doi: 10.1152/ajpregu.00549.2002 Yang, P. Y., Ho, K. H., Chen, H. C., & Chien, M. Y. (2012). Exercise training improves sleep

quality in middle-aged and older adults with sleep problems: a systematic review.

Journal of Physiotherapy, 58(3), 157-163. doi: 10.1016/S1836-9553(12)70106-6 Yildirir, A., Kabakci, G., Yarali, H., Aybar, F., Akgul, E., Bukulmez, O., . . . Oto, A. (2001).

Effects of hormone replacement therapy on heart rate variability in postmenopausal women. Annals of Noninvasive Electrocardiology , 6(4), 280-284.

Youngstedt, S. D., O'Connor, P. J., & Dishman, R. K. (1997). The effects of acute exercise on sleep: a quantitative synthesis. Sleep, 20(3), 203-214.

52

53

54

55

十、 誰可以使用您的資料:

依「人體研究法」 、 「研究用人體檢體採集與使用注意事項」及「人體 生物資料庫管理條例」規定,唯有計畫主持人、共同/協同主持人及 本計畫含括之人員可於研究進行期間依本研究所訂臨床試驗計畫使 用您的檢體,如於研究結束後仍需使用,將依法請您另簽一份同意 書。

十一、 研究結束後資料處理方法:

研究結束後,屆時將徵詢您的意見,是否願意提供後續研究使用。

十二、 如果您中途退出研究,其資料處理方法 陽明大學銷毀。

十三、 如本計畫研究成果獲得學術文獻發表、智慧財產及實質效益時,國 立陽明大學將作為從事疾病診斷、預防、治療及研究等醫學用途。

十四、 權利

1. 參加本研究皆不須繳交任何費用。

2. 您有不參加研究的權利,並有權隨時退出本研究,且不會引起任何 不愉快或影響應有的權利。

3. 研究過程中有關的任何重大發現都將提供給您。

4. 如果您因為參與本研究,而發生任何不適或疑問可隨時與計畫主持 人楊靜修聯絡(聯絡電話:02-28267000#6156) 。如您對參與研究 的相關權益有疑問,您可以和國立陽明大學人體研究暨倫理委員 會郭樓惠小姐聯絡(聯絡電話: 2826-7000分機6217或5337)

5. 您將持有一份已簽署之受試者同意書。

十五、 聲明

計畫主持人楊靜修已完整地向我說明本研究之性質與目的。計畫主持 楊靜修已回答我有關藥品與研究的問題,並已解釋我有權隨時退出研 究工作,且不會引起任何不愉快或任何不良後果。

十六、 簽名

主要主持人已詳細解釋有關本研究計畫中上述研究方法的性質與目的,及

可能產生的危險與利益。

56

57

(1) 無行為能力人(在民法是指七歲以下之兒童,法律宣告禁治產權者);由法定代 理人簽名。禁治產人由監護人擔任其法定代理人。

(2) 限制行為能力人(在民法是指七歲以上、二十歲以下之未成年人);則需受試者 與法定代理人共同簽名。

(3) 七歲~十二歲的受試者:須另加一份贊同同意書,請用圖案表示或注音,取得 其贊同。

註5. 受試者因精神障礙或其他心智缺陷,致其為意思表示或受意思表示,或辨識其意思表 示效果之能力,顯有不足,而受法院之輔助宣告者,應得輔助人之同意。

註6. 受試者雖非無行為能力或限制行為能力者,但因意識混亂或有精神與智能障礙,而無 法進行有效溝通和判斷時,由有同意權之人為之。前項有同意權人為配偶及同居之親 屬。

註7. 見證人必須由其本人簽名,並且載明日期始得生效(試驗相關人員不得為見證人)。

58

運動 每週______ 次,每次______分鐘,進行_________運動 加班 每週______ 次,每次______小時

59

60

61

附錄五

一週運動紀錄表

姓名:__________ 填表日期:____年

星期一 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期二 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期三 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期四 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期五 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期六 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間 備註:

星期日 健走活動 其他運動(類型) 1: 2: 3:

月 日 □ 是 □ 否 運動時間

62

附錄六

63

附錄七

64

個人小傳

基本資料 姓名:林怡姿 性別:女

出生地:桃園市

主修:運動生理學、腦科學 學歷

國立臺灣師範大學 運動競技學系運動科學碩士班 (2013.9~2015.8) 國立東華大學 運動與休閒學系 (2009.9~2013.6)

國立桃園高級中學 (2006.9~2009.6) 學術發表

(1) 林怡姿、楊靜修、李嘉宜 (2015)。身體活動對更年期高血壓前期婦女 的心血 管功能之影響,2015 國際運動生理及體能領域學術研討會 。 (2) 林怡姿、潘怡廷、沙部‧魯比、林嘉志 (2014)。缺血預處理對大鼠力

竭運動表現及氧化傷害的影響,2014 體育運動學術團體聯合年會暨學 術研討會 。

(3) Jung-Charng Lin, Sha Pu Lu Bi, Chia-Chih Lin, Yi-Ting Pan, Yi-TzuLin, Shih-Ling Chen. (2012). Upland Indigenous in Taiwan may Have Better Anti-oxidative Capability in Response to Endurance Exercise at Altitude.

Medicine & Science in Sports & Exercise, 44(5).

相關證照

中華健康管理協會 乙級健康管理師

中華民國水上救生協會 救生員證

中華民國紅十字會初級急救證

美國 SOLO 野外急救第一線反應員證(Wilderness First Responder)