敏捷對於老年人的身體表現、認知功能以及腦部活化之關係與影響

Abstract

背景與目的：敏捷能力被認為包含認知以及身體功能兩大面向，且被視為包含速度要求及方向變換的全身性運動。敏捷訓練目前主要被使用於年輕族群與運動員中，近期研究也開始將其應用於老年人族群上。敏捷訓練為多面向及高功能性之訓練，使得在有限的時間裡，提供更有效率的訓練。在老年人中，因衰老導致的認知功能下降、身體四肢肌肉力量的減少、體脂的百分比、身體柔軟度以及耐力的變化都會造成老年人在執行動作的過程有所困難。因此，本研究探討敏捷訓練是否能夠達成老年人身體功能及認知功能的進步，及其與腦部活化之間的關係。 研究方法：本研究共收取25位健康老年人，進行訓練前測試，內容包含敏捷表現、動作表現（行走表現、耐力、平衡、爆發力、肌力與柔軟度）、認知功能（工作記憶、模組轉換及選擇性專注及抑制力）、腦部活化以及跌倒與生活品質量表；在測試後即進行隨機控制試驗，25位受試者在訓練前測試後隨機分派至控制組以及敏捷訓練組。控制組執行8周家健康教育指引，包含有居家運動、老年人飲食建議以及防跌知識教育。訓練組進行每周2次，每次60分鐘，共8周，並以一對一的方式進行敏捷運動訓練。訓練內容包含三種環境配置，搭配不同動作指令之敏捷訓練。訓練過程依照每位受試者實際執行運動之完成與熟練度，進而調整訓練強度及難度，並於訓練後一周內執行評估測試。 結果：於訓練前之測試結果顯示，動作表現和認知功能表現與敏捷測試之完成總秒數皆有中度至高度的相關性。尤其與時間相關之項目，如：計時起走及五次坐站測試，其執行表現與敏捷測試完成所花費的時間呈現高度正相關性。此外，三種認知功能測試之反應時間及錯誤率與敏捷測試總完成時間亦呈現中度至高度的正相關性。在計時起走、雙重任務行走以及六分鐘行走測試，與速度相關之參數則與敏捷測試完成時間呈現中度至高度的負相關性。經過8週隨機控制敏捷訓練後，訓練組在敏捷測試、認知測試所需的反應時間皆顯著下降，認知測試之錯誤率也有下降的趨勢。動作表現中，在單一任務行走及六分鐘行走測試中的步態頻率呈現顯著的增加，腳踝的肌力與柔軟度也在訓練後有顯著的進步。在功能性評估量表中，兩組之跌倒自覺風險量表成績於後測皆呈現顯著的增加。在後測時，控制組在執行敏捷測試及雙重任務行走測試之整體腦部活化表現，呈現較高的活化。且執行雙重任務相較於一般單一任務行走所需額外花費的腦部活化，控制組相較訓練組於後測時整體的腦區呈現更明顯的活化趨勢。 結論： 敏捷性與認知和運動功能有著顯著的相關性。敏捷訓練融合了認知和運動要素，為一整合性訓練，使得訓練整體更加省時有效率。敏捷訓練對於提升敏捷表現、認知功能、運動功能、大腦活化、跌倒意識及生活品質上有正向改變之趨勢。

Background and Purpose: Agility comprised of cognitive and physical functions, which influences whole-body movement with change of speed and directions. Agility training is widely used in athletes, and recent studies have begun to apply it into the elderly. Agility training is a multidimensional and highly functional training, which provide higher efficiency in limited time. In elderly, the decrement of cognitive function, muscle strength, the percentage of body fat, body flexibility and endurance caused by aging limits elderly to perform functional movements safely. Therefore, it is crucial to explore whether agility training can achieve the improvement on both physical and cognitive function in elderly, and to explore the relationship between the two functions and agility ability. Method: This study recruited 25 healthy elderlies, and conducted assessment before and after the intervention. Assessment including agility ability, physical function (walking performance, endurance, balance, muscle power, muscle strength, and flexibility), cognitive function (working memory, mental set shifting, and selective attention and inhibition), brain activity, and functional scales of falling and quality of life. After pre-test, we randomly allocated 25 participants to control group and agility training group. Participants in the control group received health educational guidelines which includes the home-based exercise, nutrition recommendations, and fall prevention education. Participants in the agility training group received 16 sessions of agility training which is conducted 60 minutes of training each time, 2 times a week, a total of 8 weeks. Post-test assessment was performed after the intervention in 1-week. Results: Motor performance and cognitive function were moderately to highly correlated with overall performance of the agility test. Especially in time-related parameters, such as time up and go test (TUG), five time sit-stand tests (5STS), the performance is highly positive correlated with the time it took to complete the agility test. The reaction time and error rate of the three cognitive function tests also showed moderately to highly positive correlation with the completion time of the agility test. Speed-related parameters showed moderately to highly negative correlation with agility test consumed time in the TUG, dual-task walking (DTW), and 6-minute walking test (6MWT). After the 8 weeks of agility training, the time-consumed of the agility group in the agility test and the cognitive test decreased significantly. The error rate of the cognitive test also showed a declined trend. On the motor function, the cadence of single-task walking and the 6MWT showed a significant increment.Flexibility and the muscle strength of ankle plantarflexors and dorsiflexors also improved significantly after training. Regarding to the functional assessment scales, the scores of the Falls Efficacy Scale International (FES-I) in both groups showed a significant increase at post-test. The overall brain activation during agility test and DTW showed trends that there were higher activation in the control group than the agility group at the post-test Conclusion: Agility and cognitive and motor function are significantly correlated through this study. Agility training integrated cognitive and motor elements, and rapid movement and decision are required during exercise. Due to the integration, the agility exercise can be time-efficient. As results of the study, the agility training was beneficial to agility ability, cognitive function, motor function, brain activation, fall awareness, and quality of life.