健康體能促進課程介入對社區老人成效評估－以南投縣為例

Abstract

背景：「成功老化」是目前全球面臨人口老化國家所共同追求的理想目標。台灣快速邁向高齡社會之際，各種因人口老化伴隨而來的慢性疾病、醫療照護、失能風險、長期照護、社會保險、福利資源等等，都將為家庭、社會和國家帶來沉重的經濟負擔和各種亟需解決的課題。南投YMCA依據日本大阪YMCA失能預防經驗所設計適合台灣社區老人的「健康體能促進與失能預防課程」，以「有趣、安全、有效」之理念，增進老人身心健康、獨立自主的生活能力，進而達成國民健康署所訂定的老人健康體能促進之目標，以打造成功老化的社會。 目的：探討南投YMCA為期十週、一週一次兩小時的健康體能促進與失能預防課程介入對社區老人體適能(fitness)、運動自我效能預期(exercise self-efficacy expectation)、運動結果預期(exercise outcome expectation)以及生活品質(quality of life)的影響，與其相關影響因素。

方法：本研究之研究對象為參與課程介入之南投社區老人(實驗組，n = 42)和其他南投社區老人(對照組，n = 31)，屬於類實驗研究設計。南投YMCA的健康體能促進與失能預防課程結合健康評估與知識教育、體能訓練及團康活動，其中體能訓練以下肢肌力訓練、平衡及伸展的坐式運動為主。本研究觀察社區老人在課程介入前、後之體適能是否有改變，同時進行運動自我效能預期、運動結果預期以及生活品質之問卷前後測，以期進一步瞭解課程介入對老年人體適能、運動自我效能預期、運動結果預期和生活品質的影響。 結果：研究結果顯示，社區老人在體適能方面，實驗組代表動態平衡/敏捷度的起身行走(p < 0.001)和代表下肢肌力的屈膝起立30秒(p < 0.05)相較對照組顯著進步，在代表靜態平衡的睜眼單腳站立上，實驗組雖無顯著進步，但對照組有顯著退步(p < 0.05)的情形；在運動自我效能方面，實驗組相較對照組在運動自我效能預期上有顯著的提升(p < 0.001)；在生活品質方面，實驗組老人生理層面中的生理角色(p < 0.05)、身體疼痛(p < 0.05)、一般健康(p < 0.05)以及生理健康面(p < 0.05)和心理層面中的活力狀況(p < 0.05)，相較對照組有顯著的增加。 結論與建議：本研究結果指出，南投YMCA將日本大阪YMCA失能預防課程經由在地化的調整，於南投鄉村進行健康體能促進與失能預防課程，對於當地社區老人的體適能表現、生理與心理層面之生活品質是有助益的，也提升老人執行規律運動的自信心。建議未來能與課程介入於都市型社區的成效作相互的比較，幫助台灣各地社區瞭解最合適其當地老人的健康促進與失能預防策略。

Background: 'Successful Aging' is currently a goal for aging societies. Taiwan is moving toward an aged society. The risk of disability will increase as the population aging and may result in a heavy financial burden for Taiwanese government, society, and families. A health promotion program implemented by Nantou YMCA (The Young Men's Christian Association) in Nantou county are based on the experiences of disability prevention programs from Osaka YMCA in Japan, which emphasized on developing the concept of fun, safe and effective disability prevention programs. The program emphasizes on both physical and mental health for the elderly with the goal of enabling them to live independently, and hopefully to build a successful aging society. Objectives: The objective of the study was to investigate the effect of a community-based 10-week health promotion and disability prevention courses provided by Nantou YMCA regarding change of fitness, exercise self-efficacy expectation, exercise outcome expectation, and quality of life among older people. Methods: The study design was a quasi-experimental design. The subjects of this study were older adults participanting in Nantou YMCA health promotion courses (intervention group, n = 42) and olders adults from other Nantou communities (control group, n = 31). The health promotion and disability prevention courses provided by Nantou YMCA conbined health education, physical training and group activity. Physical training focused on increasing lower-body strength, balance and flexibility. The study conducted pre-test and post-test to investigate the changes of two groups’ fitness, exercise self-efficacy expetation, exercise outcome expetation and quality of life before and after the courses. Results: The older adults participanted Nantou YMCA health promotion courses showed significant improvement in the fitness tests of time up and go (p < 0.001) and the 30-second chair stand (p < 0.05) than older adults in the control group. Older adults in the intervention group also gained significant increases in the score of exercise self-efficacy expetation (p < 0.001) and the score of quality of life in role physical (p < 0.05), bodily pain (p < 0.05), general health (p < 0.05), sum of physical health (p < 0.05) and vatility (p < 0.05) scales than older adults in the control group. Conclusions and Recommendations: This study indicated that the health promotion program implemented by Nantou YMCA, orginated from Japan, after localizing for rural communities in Nantou county, were effective on helping community dwelling older adults to improve their physical function, physical and mental quality of life, and their confidence of exercise regularly, after revising the program to fit the culture in Nantou county. Futher study may compare with the effect of health promotion program in urban area, and find suitable strategy of health promotion in older adult in different area.