女性在不同生殖老化階段的健康體適能： 一項橫斷面研究

Abstract

背景與目的：女性在生殖過程中會經歷顯著的荷爾蒙變化，從規律的月經週期逐漸走向停經。生殖老化分期工作坊（STRAW）系統提供了標準的分類架構，將女性生殖老化分為生育期、更年期過渡期、停經期，並進一步分成停經早期與停經晚期。這些階段的賀爾蒙變化會影響多種生理功能，進而影響健康體適能。健康體適能涵蓋心肺適能、身體組成、肌力、肌耐力和柔軟度五大要素，是衡量健康的重要指標，與生活品質、日常活動能力以及多種慢性疾病風險密切相關。其中，心肺適能尤為重要，因為它是全因死亡率的獨立危險因子，對長期健康有深遠影響。心肺運動測試雖是評估心肺適能的黃金標準，但在大規模或社區研究中往往難以執行。因此，研究常以運動能力測試作為可行的替代方案。先前研究已指出年齡、身體組成及身體活動量等多種因素皆可預測運動能力，但尚未知道女性的四個生殖老化階段是否會是女性運動能力的預測因子。此外，過去針對不同生殖階段的運動能力研究結果並不一致。特別是，極少有研究比較停經早期與停經晚期的差異。因此，本研究旨在比較不同生殖老化階段女性的健康體適能、身體活動量與健康相關生活品質，並探討生殖老化階段是否是運動能力的預測因子。研究方法：本研究為橫斷式設計，收案對象為居住於台北市社區的40至65歲女性，依STRAW系統分為四組：生育期、更年期過渡期、停經早期與停經晚期。排除條件包含月經週期長期不規則；曾患或接受影響子宮、卵巢功能之疾病或手術；任何妨礙運動測試之肌肉骨骼、心血管、呼吸或神經系統疾病；惡性腫瘤病史；正在接受荷爾蒙治療、懷孕或哺乳；服用影響卵巢、肌肉或心臟功能藥物；以及測試前 24 小時內未戒除咖啡因、酒精或劇烈運動者。健康體適能由標準化的測試評估（包含運動能力測試、身體組成、上肢握力、下肢膝伸肌力、腹部肌耐力、柔軟度），身體活動量與健康相關生活品質則以問卷測量。數據分析將使用單因子獨立變異數比較不同生殖老化階段的差異，並使用多元線性迴歸探討運動能力的預測因子，顯著統計意義的標準訂為p < 0.05。結果：本研究共納入124位女性，平均年齡為53.11 ± 7.20歲。分析結果顯示四組間在骨骼肌率（p < 0.001）、體脂率（p = 0.010）、上肢握力（p = 0.008）、下肢膝伸肌力（p = 0.003）、運動能力（p = 0.020）以及久坐時間均有達到顯著差異（p = 0.023）。在健康相關生活品質方面，僅在活力這項達到顯著差異（p = 0.037）。迴歸分析顯示，運動能力與靜止心率（β = -0.500, p < 0.001）及體脂率呈顯著負相關（β = -0.306, p < 0.001），此外，運動能力與劇烈身體活動量（β = 0.177, p = 0.010）以及SF-36問卷的身體功能（β = 0.217, p = 0.002）呈顯著正相關。結論：本研究發現，在健康體適能、久坐時間與健康相關生活品質之間，皆有組別間的顯著差異。其中，停經過渡期女性的健康體適能最高，而停經晚期女性則是最低。而運動能力在中年女性中與身體活動量和SF-36問卷的身體功能呈正相關，與靜止心率和體脂則呈負相關。研究結果顯示，維持足夠的身體活動量與健康的身體組成，對中年女性保持健康體適能及預防功能衰退至關重要。未來研究應透過縱向設計與更大且多元的樣本、結合荷爾蒙檢測、使用更多客觀身體組成與身體活動量量測工具、使用隨機的方式招募受試者、以及結合職業與心理社會因素的探討，以更全面了解生殖老化對女性體適能與健康的影響。

Background and purpose: Women undergo significant hormonal changes during the reproductive aging process, transitioning from regular menstrual cycles to menopause. The Stages of Reproductive Aging Workshop (STRAW) system classifies reproductive aging into three stages: reproductive stage, menopausal transition, and postmenopause, which is further divided into early and late postmenopause. Hormonal fluctuations across these stages affect various physiological functions and health-related physical fitness (HRPF), which comprises cardiorespiratory fitness, body composition, muscle strength, muscle endurance, and flexibility. HRPF is closely related to health, health-related quality of life (HRQoL), daily functioning, and chronic diseases risk. Among these components, cardiorespiratory fitness is particularly important, as it is an independent predictor of all-cause mortality. While cardiopulmonary exercise testing is considered the gold standard for assessing cardiorespiratory fitness, it is often impractical in large-scale or community-based studies. Therefore, exercise capacity tests are widely used as feasible alternatives. Previous research has identified age, body composition, and physical activity as predictors of exercise capacity. However, it remains unclear whether reproductive aging stages serve as predictors. Moreover, findings on exercise capacity across these stages are inconsistent, and few studies have examined the differences between early and late postmenopause. Therefore, this study aimed to compare HRPF, physical activity levels, and HRQoL across different reproductive aging stages in women and to examine whether reproductive aging stages are predictors of exercise capacity in middle-aged women. Methods: This cross-sectional study recruited community-dwelling women aged 40–65 years in Taipei and classified them into four groups according to the STRAW system. Women with menstrual irregularities, gynecologic disorders or surgeries, diseases limiting exercise testing, malignancy, hormone therapy, pregnancy or lactation, medication use affecting ovarian, muscular, or cardiac function, or who did not abstain from caffeine, alcohol, or vigorous activity within 24 hours were excluded. HRPF was assessed through standardized tests, including exercise capacity, body composition, grip strength, knee extensor strength, abdominal muscle endurance, and flexibility. Physical activity and HRQoL were measured using validated questionnaires. Group differences were analyzed using one-way independent analysis of variance (ANOVA), and multiple linear regression was applied to identify predictors of exercise capacity. Statistical significance was set at p < 0.05. Results: The study included 124 participants (mean age = 53.11 ± 7.20 years). Significant group differences were found in skeletal muscle percentage (p < 0.001), body fat percentage (p = 0.010), grip strength (p = 0.008), knee extensor strength (p = 0.003), exercise capacity (p = 0.020), and sedentary time (p = 0.023). For HRQoL, only vitality differed significantly (p = 0.037). Regression analysis revealed that exercise capacity was negatively associated with resting heart rate (β = -0.500, p < 0.001) and body fat percentage (β = -0.306, p < 0.001), while positively associated with vigorous physical activity levels (β = 0.177, p = 0.010) and physical functioning of the SF-36 (β = 0.217, p = 0.002). Conclusions: This study showed that HRPF, sedentary time, and HRQoL significantly differed across reproductive aging stages. Women in the menopausal transition showed the highest HRPF, whereas late postmenopausal women had the lowest. Exercise capacity was positively associated with physical activity and physical functioning of the SF-36; and negatively associated with resting heart rate and body fat. These findings highlight the importance of maintaining physical activity and healthy body composition to preserve HRPF and reduce functional decline in middle-aged women. Future research should investigate longitudinal designs with larger and more diverse samples, incorporate hormonal measurements, use more objective tools for body composition and physical activity levels, employ random sampling strategies, and conduct intervention trials to comprehensively understand the impact of reproductive aging on women’s health.