單次有氧運動對於青年注意力不足過動症患者之大腦神經生理與認知功能之介入成效

Abstract

研究背景：注意力不足過動症為常見神經發展障礙疾病，全球成人盛行率為2.58%，衛福部統計顯示，台灣成人盛行率為3-4%。注意力不足過動症所伴隨的認知功能變化，包含動作學習、工作記憶和反應抑制等，是近幾年極受關注的議題。過去研究指出，有氧運動對於人類之認知功能影響非常顯著，這可能與有氧運動對於大腦之神經生理作用相關。然而目前未有系統性的研究，針對單次性有氧運動對於成人注意力不足過動症患者之大腦神經生理作用與認知行為的表現進行探討。 研究目的：本研究將結合非侵入性腦刺激術與認知行為測驗，探討有單次性有氧運動對於成人注意力不足過動症患者之大腦皮質興奮性與認知功能之影響。 研究方法：本研究將以隨機分配之實驗設計，共招募8位健康年輕成年人與8位成人注意力不足過動症患者，受試者將參與四次的實驗，每次實驗間隔至少一週，受試者將參與兩次的有氧運動介入(騎室內腳踏車30分鐘)與兩次的控制組介入(坐在舒適的椅子上休息30分鐘)。研究人員將會在介入前後評估受試者之大腦皮質興奮性與認知功能。 評估工具為經顱磁刺激(大腦皮質興奮性)、序列反應作業(內隱動作學習)、3-Back task(工作記憶)和停止信號作業(反應抑制)。使用2X2混合模型ANOVA進行統計分析，當顯著差異時進行配對t檢驗，顯著水準皆設定為0.05。 研究結果：主要結果顯示運動前，在大腦皮質興奮性，與對照組相比時，注意力不足過動症組表現出較低的短間隔皮質內抑制和較高的皮質內促進 (p<.05; p<.05) ；在內隱運動學習測驗上，有較高錯誤率和較長反應時間。但在工作記憶和反應抑制測驗上，兩組並無顯著差異。 此外，在單次有氧運動後，與對照組相比，注意力不足過動症組明顯提升短間隔皮質內抑制和減少皮質內促進 (p<.05; p<.05)；在內隱運動學習測驗上，呈現較高錯誤率 (p<.05)，但反應時間顯著性減少 (p<.05)。在工作記憶和反應抑制測驗上，兩組仍無顯著差異。 結論：在單次有氧運動後，注意力不足過動症組短間隔皮質內抑制明顯升高，皮質內促進降低，認知測驗上的反應時間加快。本研究顯示有氧運動可為成人注意力不足過動治療方式之一，其優點為成本低、易於實施和非侵入性治療。此外，本研究針對有氧運動對成人注意力不足過動症的相關神經生理過程，提供部分實證。

Backgrounds：Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. The global prevalence of ADHD in adults is 2.58%. The prevalence of ADHD is 3-4% according to the Ministry of Health and Welfare in Taiwan. The deficits in cognitive function in adults ADHD such as implicit motor learning, working memory and response inhibition have been a great concern in recent years. Aerobic exercise has a significant impact on human cognitive function. The underlying mechanism might be the positive effects of aerobic exercise on neurophysiological system in humans. However, there is few research explore the effects of acute aerobic exercise on the brain neurophysiology and cognitive performance in adults ADHD. Purpose：This study will integrate non-invasive brain stimulation and cognitive tasks to explore the effects of acute aerobic exercise on the cortical excitability and cognitive function in young adults with ADHD. Methods：Eight ADHD subjects and 8 matched healthy controls were assessed by transcranial magnetic stimulation (TMS) and cognitive function before and after exercise and control (rest) intervention. TMS was used to assess cortical excitability, as well as the Serial reaction time task (SRTT) for implicit motor learning, the 3-back task for working memory, and the Stop signal task (SST) for response inhibition. A 2 (group: ADHD/control group) X 2 (condition: moderate aerobic exercise/control) mixed model ANOVA was applied to investigate the outcome of group and conditions, and the paired t-test was performed when ANOVA reveal significant difference on conditions (moderate aerobic exercise/control). Results：The main findings found that the ADHD group showed lower short-interval cortical inhibition (SICI) and higher intracortical facilitation (ICF) with TMS (p<.05; p<.05), as well as a higher error rate and longer response time on implicit motor learning (p<.05; p<.05) when compared to controls and no differ on working memory and response inhibition before intervention. Furthermore, after acute exercise, the ADHD group had significantly enhanced SICI and diminished ICF which compared to control group (p<.05; p<.05). The ADHD group still makes more mistakes on implicit motor learning (p<.05), but their reaction time quickly on implicit motor learning (p<.05) following exercise and still non-significant on working memory and response inhibition. Conclusion：the ADHD group had considerably higher SICI, lower ICF and faster reaction time after acute exercise. The present study explored the effect of acute exercise on cortical excitability and in adult ADHD subjects. Aerobic exercise may be useful as a supplementary therapy because of its low cost, easy implementation, and non-invasiveness. Even though, it provides a cue for the related neurophysiological processes of adult ADHD after aerobic exercise.