輕度先天性心臟病青少年運動行為之決定因素探討

Abstract

背景：近年來由於醫療進步，使得患有先天性心臟病兒童存活至青少年以上的人數已大幅提升，且大多數的病童在手術後的心肺功能和運動能力可達到一般兒童的程度。然而，病童成長至青少年時期實際從事的運動行為以及決定其運動行為的因素，都值得進一步地探討。 目的：本研究目的在檢視輕度先天性心臟病青少年從事的運動量和強度，並探討個人運動的信念、人際間對運動的影響以及物理環境的運動可利用性等因素對其從事運動行為的影響。 方法：本研究採重複測量設計法，研究對象為12-18歲患有先天性心臟病且不須限制運動量或僅須限制重度運動的學生。本研究有兩次資料收集時間點，第一次為2008年7-8月暑假期間，於北部某三所醫學中心的小兒心臟科門診收集；第二次為2008年12月在學期間。資料的收集是以問卷的方式進行，問卷包括：基本資料，運動行為，個人運動的信念，包含：運動自我效能、自覺運動益處和障礙，人際間對運動的影響，包含：來自有意義他人的運動支持、模範和限制，以及物理環境的運動可利用性等，並以結構方程模式進行資料分析。 結果：輕度先天性心臟病青少年於暑假期間較在學期間從事較多的輕度運動和總運動量；然而，在學期間較暑假期間從事較多的重度運動量。輕度先天性心臟病青少女較男生從事較少的中度運動量、重度運動量和總運動量。此二個時期，青少年從事運動的強度和心臟科醫師所建議的運動強度之間並無顯著的差異。但於暑假期間，不限運動者當中約有62%應參考心臟科醫師的建議可從事重度運動，卻沒有從事重度運動；於在學期間，須限制重度運動者當中更有高達七成應參考心臟科醫師的建議限制重度運動，反而有從事重度運動。青少年於二個時期皆可透過個人運動的信念作為中介變項，顯著地影響其人際間對運動的影響對其從事中重度運動量之效應。並藉由修正模型進一步發現同儕的影響，可藉運動自我效能作為中介變項，來影響其中重度運動行為。且青少年分別於暑假和在學二個期間運動行為的決定因素並沒有顯著的不同。青少年自覺運動益處愈多，導致於在暑假期間從事愈多的輕度運動和總運動量，但在學期間從事愈少的輕度運動和總運動量。而家庭的影響愈大，亦導致於在暑假期間從事愈多的輕度運動量，但在學期間從事愈少的輕度運動量。 結論：輕度先天性心臟病青少年於暑假期間從事較多的運動量；但在學期間從事較多的重度運動量。值得注意的是，仍有相當比例的青少年未符合心臟科醫師所建議的運動量，且個人運動的信念中的自我效能在決定從事中重度運動行為方面佔有重要的影響性。本研究結果將可作為指導輕度先天性心臟病青少年從事運動行為之依據，並提供未來發展健康促進研究介入措施以及相關健康政策之重要參考。

Background: Due to medical advances, most children with congenital heart disease (CHD) are expected to survive to adolescence, even to adulthood. Evidence indicates that their cardiopulmonary function and exercise capacity can reach the level of normal children after surgical repair. However, it is necessary to further investigate the performance in exercise behavior and the determinants of exercise behavior for adolescents with CHD. Purposes: The purposes of this study were to investigate the amount and intensity of exercise that adolescents with mild CHD engaged in, and to examine the determinants of personal exercise beliefs, interpersonal influences on exercise and availability of physical environment among adolescents with mild CHD. Methods: The research utilized a repeated measures design. The research subjects were the 12 to 18 year-old students with CHD whose exercise with no limits and vigorous exercise limits only recommended by cardiologists. There were two times for data collection: one was the summer vacation in July-August, 2008 from the pediatric cardiology outpatient departments at three large medical centers in the northern Taiwan. The other one was the semester in December, 2008. The method of data collection was survey by self-reported questionnaires, including demographic data, exercise behavior, exercise self-efficacy, perceived benefits and barriers for exercise, exercise support, modeling and restrictions from significant others, and availability of physical environment for exercise. Structure equation modeling was performed to analyze data. Results: The respondents during summer vacation engaged in significantly more mild and total exercise than they did in fall semester. The respondents during summer vacation engaged in significantly less vigorous exercise than they did in fall semester. The female respondents engaged in significantly less moderate, vigorous, and total exercise, but non-significant in mild exercise, when compared with male peers. There was no significant difference in the exercise intensity between the respondents engaged in and the cardiologists recommended during these two periods. Approximately 62% of respondents with no exrcise limits recommended by cardiologists did not engage in vigorous exercise in summer vacation, whereas 70% of respondents with vigorous exercise limit only recommended by cardiologists engaged in vigorous exercise in fall semester. The effect between interpersonal influences on exercise and moderate-to-vigorous exercise was mediated by personal exercise beliefs. Based on the revised model, peer influences showed significant effects on moderate-to-vigorous exercise by the mediator of exercise self-efficacy. There was no significant difference in the determinants of exercise behavior during two periods. More exercise benefits the respondents perceived, more mild and total exercise they engaged in summer vacation, and less mild and total exercise they engaged in fall semester. More family influences the respondents received, more mild exercise they engaged in summer vacation, and less mild exercise they engaged in fall semester. Conclusions: Adolescents with mild CHD engaged in more exercise during summer vacation, but more vigorous exercise occurred in the fall semester. A noteworthy percentage of adolescents with mild CHD did not follow the exercise intensity recommended by cardiologists. The self-efficacy in personal exercise beliefs played the important role in determining the performance of moderate-to-vigorous exercise. The results of this study may provide appropriate exercise behavior suggestions among adolescents with mild CHD and may be the clinical references for health professionals, the evidence of contextual intervention strategies, and related health policies for promoting exercise behavior among adolescents with mild CHD.