早期太極拳運動對慢性阻塞性肺疾住院病患之運動耐力、焦慮憂鬱及生活品質的長期成效

Long-term effects of early Tai Chi on exercise tolerance, anxiety, depression, and quality of life in hospitalized patients with chronic obstructive pulmonary disease

目標：早期運動有助於慢性阻塞性肺疾病急性發作（Acute Exacerbation of Chronic Obstructive Pulmonary Disease, AECOPD）的住院病患快速回復，但未有研究探討早期太極拳運 動的長期成效，故本研究旨在檢測AECOPD住院病患接受早期太極拳運動訓練在運動耐力、焦 慮憂鬱、生活品質與生物標誌物的長期成效。方法：本研究採類實驗設計，立意取樣自雲嘉三 間醫院，共31人參與此研究（實驗組，n=17及常規照護的對照組，n=14）。收集6次資料，分 別是介入前、出院日、出院後1週、1、3及6個月。運用廣義估計方程式分析太極拳運動成效。 結果：實驗組比對照組在出院後1週（p=0.008）及第6個月（p=0.012）有較佳的運動耐力表 現；實驗組比對照組在出院後第3個月生活品質明顯改善（p=0.040）；實驗組與對照組相比， 實驗組在出院後第3個月第六型介白質（Interleukin-6, IL-6）和C-反應蛋白（C-reactive protein, CRP）的改善幅度，分別減少15.67（pg/ml）（p=0.017）與17.46（ug/ml）（p=0.013），獲得顯著 成效。然而在焦慮憂鬱、YKL-40和LCN2的分析上，兩組未達顯著差異。結論：住院期間介入早期 太極拳運動可增進病患之運動耐力、生活品質及降低發炎反應且安全可行。此研究結果可供臨床 醫護人員做為日後推動住院COPD病患早期運動的實證基礎。

Objectives: Early sustained exercise can help patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) to quickly return to a steady state; however, to the best of our knowledge, no previous studies have examined the long-term effects of early TaiChi or Tai Chi as a bridge between early exercise during hospitalization and exercise at home. The aim of this study was to examine the effects of early Tai Chi on exercise tolerance, anxiety, depression, health-related quality of life and biomarkers in hospitalized patients with AECOPD. Methods: A quasi-experimental study was conducted. A purposive sampling of 31 patients with AECOPD (experimental group n=17 and control group n=14) was selected from hospitals in the Yunlin-Chiayi area. Data were collected during pre-intervention, at discharge, and one week, one month, three months or six months after discharge. Generalized estimating equations were used to examine the effects of the Tai Chi training intervention. Results: The experimental group had better exercise tolerance than did the control group one week after discharge (p=0.008) and six months after discharge (p=0.012). The experimental group had a better quality of life than the control group three months after discharge (p=0.040). The experimental group had decreased biomarker levels (Interleukin-6, p=0.017 and C-reactive protein, p=0.013) more than the control group three months after hospitalization. Anxiety, depression, and other biomarkers (YKL-40 and LCN2) failed to find statistical significance. Conclusions: Early Tai Chi helped promote early exercise in patients with AECOPD.