六分鐘行走測試與折返行走測試於COPD個案運動能力測試的應用

Application of the 6-Minute Walking Test and Shuttle Walking Test in the Exercise Tests of Patients With COPD

慢性阻塞性肺病穩定期的個案管理，特別強調給予運動訓練。適當的運動訓練，能夠增進慢性阻塞性肺病個案的尖峰攝氧量、減少呼吸困難、倦怠感、住院率與死亡率，進而增進其運動能力及改善健康相關的生活品質。但是慢性阻塞性肺病個案對運動的耐受度較差，約有51%個案有活動受限狀況，而活動受限又限制其運動能力，形成惡性循環。因此個案在運動訓練前，應先做個別性的運動測試，瞭解其運動的能力及評估訓練的限制，以決定適當的運動訓練強度。慢性阻塞性肺病病人的運動測試結果是預後的重要指標。目前常用的功能性運動測試主要為六分鐘行走測試及增速性折返行走測試，兩者都是以行走的距離來評估個案的運動能力。國內護理相關雜誌發表的文章，大多以六分鐘行走測試來評估慢性阻塞性肺病人的運動能力，較少關於增速性折返行走測試。本文主要目的在介紹此兩種運動測試的做法、優點、缺點與應用，以做為進行慢性阻塞性肺病病人運動測試的臨床指引。

Exercise training improves the management of stable chronic obstructive pulmonary disease (COPD). COPD patients benefit from exercise training programs in terms of improved V4O2 peak values and decreased dyspnea, fatigue, hospital admissions, and rates of mortality, increasing exercise capacity and health-related quality of life (HRQOL). COPD is often associated with impairment in exercise tolerance. About 51% of patients have a limited capacity for normal activity, which often further degrades exercise capacity, creating a vicious circle. Exercise testing is highly recommended to assess a patient's individualized functions and limitations in order to determine the optimal level of training intensity prior to initiating an exercise-training regimen. The outcomes of exercise testing provide a powerful indicator of prognosis in COPD patients. The six-minute walking test (6MWT) and the incremental shuttle-walking test (ISWT) are widely used in exercise testing to measure a patient's exercise ability by walking distances. While nursing-related articles published in Taiwan frequently cite and use the 6MWT to assess exercise capacity in COPD patients, the ISWT is rarely used. This paper introduces the testing method, strengths and weaknesses, and application of the two tests in order to provide clinical guidelines for assessing the current exercise capacity of COPD patients.