運動訓練對矯治後先天性心臟病兒童在運動能力、身體活動、健康相關生活品質的效果

Abstract

研究背景與目的：許多研究顯示先天性心臟病童經手術矯治後，運動能力、身體活動、健康相關生活品質仍明顯低於健康兒童。本研究之目的在探討靜態不活動之先天性心臟病童與健康兒童於運動訓練後，在運動能力、身體活動、健康相關生活品質與影響身體活動之心理社會因素的效果，並比較兩組進步程度情形。方法：收入33位靜態不活動之先天性心臟病童，再徵召27位年齡和發展相似之健康、靜態不活動兒童作為對照組，兩組依性別、青春期分期隨機分層分組至運動組和控制組。運動組接受12週、每週兩次監督下和一次居家的跳舞機運動訓練，控制組則未給予任何介入。運動介入前後分別進行最大運動測試、非侵入性心臟功能與血液動力學測試、7日計步器身體活動測量，並回答健康相關生活品質與影響身體活動之心理社會因素問卷。統計分析以獨立t檢定及卡方檢定比較先天性心臟病童及健康兒童前測之差異；以2×2重複變異數分析比較所有參數之組間與組內之差異，若前測有差異，則以該依變項之前測做為共變數進行2×2共變項分析；最後，以獨立t檢定分析先天性心臟病與健康兒童運動組在最大攝氧量、靜態不活動時間、身體活動步數之改變百分比的差異；運動組受試者之最大攝氧量、靜態不活動時間、身體活動步數之改變百分比皆以皮爾森相關性分析。結果：先天性心臟病與健康兒童之前測在二氧化碳製造量、肺部通氣量、氧脈、身體不適、認知功能具有顯著差異。運動訓練後，先天性心臟病兒童在最大攝氧量、最大心率、二氧化碳製造量、第3分鐘恢復心率、週末平均步數相較於控制組有顯著改善，但只有氧脈、每分鐘通氣量、週間與每日平均步數，具有顯著之組間差異；而靜態不活動健康兒童相較於控制組在運動訓練後，其最大攝氧量、二氧化碳產生量、氧脈有顯著增加，而每分鐘通氣量、第1分鐘恢復心率、週末不活動時間則具有顯著之組內差異；先天性心臟病與健康兒童之運動組在週末平均步數改變之百分比具顯著差異；相關性分析結果僅有健康兒童之最大攝氧量改變百分比與週間不活動改變百分比有顯著相關。結論：本研究之運動訓練能有效改善矯治後先天性心臟病童與靜態不活動健康兒童之運動心肺能力，並有助於身體活動的增加與靜態不活動減少。

Background and Purpose: Many studies have shown that children with congenital heart disease (CHD) had lower values in exercise capacity, physical activity (PA), and health-related quality of life (HRQoL) even years after the correction of their defects than their healthy counterparts. The purpose of this study was to investigate the effects of exercise training on exercise capacity, PA, HRQoL, and the psychosocial factors affecting PA in sedentary CHD children and healthy sedentary children. The degree of improvement after exercise training were compared between CHD children and healthy sedentary children. Method: Thirty-three children with CHD who ever accepted correction and had sedentary life style were recruited from the pediatric outpatient departments. Additional 27 healthy children with matched age and puberty stage were recruited for comparisons. They were assigned to exercise or control group by stratified randomization according to their gender and puberty stage. Both exercise groups took 12-week exercise training, twice in hospital and once at home, using a video game so-called Dance Dance Revolution (DDR), while the control group kept their daily routines. Each subject took a maximal treadmill exercise test, 7-day PA measurement by pedometer, and questionnaires for HRQoL and psychosocial influences on children’s PA before and after 12 weeks. Independent t test and Chi-square test were used to compare the baseline data between CHD group and healthy group. Two by two repeated measure ANOVA was utilized to compare the difference of all variables between groups and within groups (pre-and post-test). A 2 x 2 ANCOVA was used if significant baseline differences were found, the baseline value was used as the covariate. Independent t test was used to compare the percentage change in exercise capacity, daily inactivity time and daily steps took between the CHD and healthy exercise groups. The percentage change of VO2max, daily inactivity time and daily steps walked were analyzed by using Pearson’s correlation coefficients. Results: The VCO2, VE, VT, O2 pulse, physical complaints, and cognitive function were significant different between CHD and healthy groups. After DDR exercise training, the children with CHD were significantly improved in VO2max, HRmax, VCO2, 3-min HR recovery, daily steps taken in the weekend. The within group difference was only observed in O2 pulse, VE, daily steps in weekdays and average daily steps taken. The sedentary healthy children improved in VO2max, VCO2, and O2 pulse after training, the within group difference was observed in VE, 1-min HR recovery, and inactivity time in the weekend. In addition, CHD children in exercise group had greater improvement in the percentage change of daily steps in the weekend than the healthy children of exercise group. The correlation analysis results demonstrated significant correlation between in the percentage change of VO2max and inactivity time in weekdays only for healthy children. Conclusion: Exercise training using DDR proved to improve the exercise capacity of sedentary children with CHD after the corrective procedures and healthy children and to enhance their habitual PA and decrease their daily inactivity time.