八段錦身心運動於思覺失調症個案的應用與效益

Abstract

背景與研究目的 認知功能缺損是思覺失調症患者的核心症狀之一，需積極介入以避免功能衰退。八段錦與健走作為潛在介入方式，過去研究顯示對思覺失調症患者具療效潛力。本研究旨在探討八段錦與健走對思覺失調症患者的可行性，以及認知功能與身體功能之效益，並進一步檢驗六分鐘步行測驗應用於思覺失調症運動介入研究中的長期穩定性、建構效度、反應性、最小可偵測變化（minimal detectable change, MDC95）及最小臨床重要差異（minimal clinically important difference, MCID）。 研究方法 本研究為單盲、三組平行設計之隨機對照試驗，共納入60位思覺失調症患者，隨機分派至八段錦組、健走組或衛教對照組。各組每週介入 3 次、每次 60 分鐘，持續 12 週，之後進行 4 週維持期訓練。介入可行性以出席率、運動強度、自覺用力程度、維持期參與情形及不良事件進行評估。受試者皆於三個時間點接受評估：前測、介入後之後測、以及介入後四週的追蹤測。主要結果為認知功能，使用思覺失調症簡式認知功能評估進行評估。次要結果包含步行能力、下肢肌力、功能性移動、雙重任務表現、情緒與睡眠品質，分別使用六分鐘步行測驗、30 秒坐站測驗、計時起走測驗、雙重任務計時起走測驗、憂鬱焦慮壓力量表－21 題版及匹茲堡睡眠品質指數進行評估。 第二部分為六分鐘步行測驗 (6MWT)測量特性之次級分析，共納入 70 位思覺失調症患者，檢驗其長期穩定性、建構效度、反應性與最小可偵測變化量，並分別採用錨定法與分布法估計最小臨床重要差異。 研究結果 與衛教組相比，八段錦組於介入後在語詞記憶、注意力與訊息處理速度、下肢肌力、平衡與雙重任務表現等方面皆有顯著改善。健走組則在工作記憶、下肢肌力與步行距離方面有顯著改善。兩運動組於介入後及追蹤測之整體認知功能皆優於衛教組（組別效應：F = 14.29, p < .01, η² = 0.34），且上述效益大致可維持至追蹤階段。八段錦組與健走組的出席率分別為 95.69 ± 4.37% 與 95.14 ± 4.31%，且未發生不良事件。兩運動組皆呈現步行能力改善（6MWT 組別效應：F = 8.17, p < .01, η² = 0.22），而八段錦在認知雙重任務表現具有額外優勢（F = 14.63, p < .01, η² = 0.34）。 在六分鐘步行測驗之測量特性方面，其長期穩定性優異（ICC = 0.96, 95% CI = 0.93–0.97），95% 信賴水準之最小可偵測變化量（MDC95）為 37.19 公尺，且具有高度反應性（SRM = 1.12）。錨定法與分布法估計之 MCID 分別為 33.70 公尺與 32.56 公尺，顯示約 32–34 公尺的改善可視為具有臨床意義的變化。 結論 本研究結果呈現了八段錦與健走，對於思覺失調症之認知功能與身體功能不同之效益。兩種運動介入皆具有可行性，而八段錦在平衡與雙重任務表現方面具有額外效益。另一方面，六分鐘步行測驗在思覺失調症患者中具有優異長期穩定性、可接受之測量誤差、建構效度與良好反應性，可作為臨床與研究中監測運動介入後功能性步行能力變化之實用工具。本研究所估計之 MCID 亦可進一步提供判斷運動介入後功能改善之臨床解釋依據。

Background and Purpose Cognitive impairment is one of the core symptoms of schizophrenia and requires active intervention to prevent functional decline. Baduanjin and brisk walking have shown therapeutic potential as intervention strategies for individuals with schizophrenia. This study aimed to examine the feasibility and effects of Baduanjin and brisk walking on cognitive and physical functions in individuals with schizophrenia. In addition, this study investigated the long-term stability, construct validity, responsiveness, minimal detectable change (MDC), and minimal clinically important difference (MCID) of the Six-Minute Walk Test (6MWT). Methods This study was a single-blind, three-arm, parallel-group randomized controlled trial. A total of 60 individuals with schizophrenia were randomly assigned to the Baduanjin, brisk walking, or health education group. Participants received training three times per week, 60 minutes per session, for 12 weeks, followed by a 4-week maintenance program. Feasibility was evaluated based on attendance, exercise intensity, perceived exertion, maintenance-phase participation, and adverse events. Participants were assessed at baseline, post-intervention, and 4-week follow-up. The primary outcome was cognitive function assessed using the Brief Assessment of Cognition in Schizophrenia. Secondary outcomes included walking capacity, lower-limb strength, functional mobility, dual-task performance, mood, and sleep quality, assessed using the 6MWT, 30-Second Chair Stand Test, Timed Up-and-Go Test, dual-task Timed Up-and-Go Test, Depression Anxiety Stress Scale-21, and Pittsburgh Sleep Quality Index. A secondary clinimetric analysis of 70 individuals with schizophrenia examined the long-term stability, construct validity, responsiveness, and minimal detectable change of the 6MWT. The minimal clinically important difference was estimated using both anchor- and distribution-based approaches. Results Compared with the health education group, the Baduanjin group showed significant improvements in verbal memory, attention and processing speed, lower-limb strength, balance, and dual-task performance, whereas the brisk walking group showed improvements in working memory, lower-limb strength, and walking distance. Both exercise groups also demonstrated better global cognition than the health education group at post-intervention and follow-up (group effect: F = 14.29, p < .01, η² = 0.34). These benefits were largely maintained at follow-up. Attendance rates were high in the Baduanjin (95.69 ± 4.37%) and brisk walking (95.14 ± 4.31%) groups, with no adverse events reported. Both groups showed significant benefits in walking capacity (6MWT group effect: F = 8.17, p < .01, η² = 0.22), whereas Baduanjin showed additional advantages in cognitive dual-task performance (F = 14.63, p < .01, η² = 0.34). Regarding the measurement properties of the 6MWT, long-term stability was excellent (ICC = 0.96, 95% CI = 0.93–0.97), with an MDC95 of 37.19 m and large responsiveness (SRM = 1.12). The anchor- and distribution-based MCIDs were 33.70 m and 32.56 m, respectively, suggesting that an improvement of approximately 32–34 m may represent clinically meaningful change. Conclusions The findings demonstrate the differential benefits of Baduanjin and brisk walking for cognitive and physical functions in individuals with schizophrenia. Both interventions appeared feasible, while Baduanjin showed additional benefits for balance and dual-task performance. The 6MWT demonstrated excellent long-term stability, acceptable measurement error, construct validity, and good responsiveness. The estimated MCID provides additional clinical interpretability for evaluating functional improvement following exercise interventions.