| 摘要: | 研究背景與目的
台灣為末期腎臟病變盛行率及發生率極高的國家，選擇血液透析者居多數，常規血液透析病患因疾病相關因素造成許多生理、心理及社會症狀如：疲憊感受、睡眠障礙，影響生活品質，相關研究指出有規律運動行為的透析病患，憂鬱與疲憊程度較低，有利於提昇生活品質，有鑑於此，本研究於透析治療過程中介入運動訓練，期改善血液透析患者之身體組成、疲憊感受及生活品質。
研究方法
本研究採類實驗研究方法，由106年4月起收案，依據G Power檢力估算收案人數，及考量個案資料流失與不全之相關因素，收案個案數共計36名，採隨機分派為對照組與實驗組兩組，各有18名。對照組樣本於血液透析時接受常規護理，而實驗組接受常規護理及8週的運動訓練，運動訓練內容為於透析過程之第2小時開始進行腳踩復健器材30分鐘，每週三次，共持續8週，再收集介入運動前、介入運動後第4週及第8週的身體組成、疲憊感受及生活品質之資料，資料收集後進行統計分析。
研究結果
研究結果顯示實驗組18位研究對象，在身體組成、疲憊感受及生活品質差異如下，身體組成於第4週之身體總水分、肌肉量、身體細胞質量、基礎代謝率明顯高介入運動前(p<0.05)；疲憊感受量表中的日常活動減退構面，在介入運動後第4週[5.78(5.25-6.30)分]第8週的得分[5.67(5.05-6.28)分]低於介入運動前的得分[7.06 (6.08-8.04)分]，且達統計之意義；生活品質量表的整體評價生活品質、滿意自己健康以及生理範疇，均在介入運動第8週時的平均得分高於介入運動前，且均達統計意義(p<0.05)。
實驗組及對照組兩組組間雖在疲憊感受及生活品質成效未具差異，但在身體組成中之身體總水分、肌肉量、身體質量指數、身體細胞質量、基礎代謝率等之平均數，實驗組明顯高於對照組，且具統計意義；故運動訓練可改善血液透析患者之身體組成成分。
研究結果之建議
透析中的運動訓練改善身體組成，疲憊感受及生活品質在實驗組及控制組之間雖無差異；然在實驗組卻可發現，運動訓練後的疲憊感受及生活品質優於運動訓練前的得分，且具統計之意義，故運動介入對於血液透析患者身心具正向效益，故建議血液透析中心可推展於透析過程中執行運動計畫，並將運動列為常規照護模式，以提昇血液透析患者之身心感受；本研究也建議將此運動訓練標準化，納入更多的血液透析個案，透過更多研究結果驗證血液透析過程給予運動訓練正向效益之外在效度。
Background and Purposes
Incidence and prevalence rates of end stage renal disease were extremely high in Taiwan. Hemodialysis accounts for most dialysis modalities in Taiwan. In chronic hemodialysis patients, disease-related factors cause many physiological, psychological and social symptoms, such as fatigue, sleep disorder and life quality. Associated studies showed that higher self-efficacy and lower degree of depression and fatigue in dialysis patients with regular exercise behavior. In views of these, our study aims to evaluate exercise training intervention for dialysis patients to improve body composition, fatigue and quality of life.
Methods
This is a quasi-experimental study which included 36 cases from April, 2017 according to G power and relevant factors of case flow and incomplete information. The patients were be randomly assigned to two groups, divided into the control group and the experimental group with respectively 18 cases in each group. The control group received routine nursing care, while the experimental group received routine nursing care and eight weeks of exercise training.
The exercise training consisted of stepping on electric rehabilitation devices for 30 minutes since the second hour during hemodialysis three times a week for 8 weeks. Data was collected before exercise training, 4 weeks and 8 weeks after training. The main measurements included body composition analyses, fatigue scales and life-quality questionnaires. Statistical analysis will be done after data collection.
Results
The research results of differences in body composition, fatigue, and quality of life were as below. After exercise intervention, total body water, muscle mass, body cellular mass and basal metabolic rate in the 4th week were higher than those before exercise (p<0.05). Fatigue scores in the 4th week and 8th week were significantly lower than that before exercise training (p<0.05 and p<0.005 respectively). Life-quality questionnaires showed higher scores in the 8th week in overall quality of life evaluation, Self-health satisfaction and physiological category compared with those before exercise (p<0.05).
There were no differences in fatigue and quality of life between experimental and control group, but total body water, muscle mass, body mass index, body cellular mass and basal metabolic rate in experimental group were significantly higher than those in control group. Thus, exercise training could increase muscle mass and body mass that corollary improve muscle atrophy.
Recommendations of Research Findings
Intradialytic exercise significantly changed body composition and prevent muscle atrophy. No differences in fatigue and quality of life were found between two groups but intragroup difference was noted in experimental group. Therefore, exercise intervention had positive effect on psychological feelings in hemodialysis patients. Therefore, intradialytic exercise is recommended and associated intervention can be promoted at the level of dialysis centers to classify exercise as a regular care model and to track outcomes continuously, and to encourage comparisons between studies. It is recommended that these research methods be standardized to include more cases and ethnic groups to maximize their research results and effectiveness. |
