整合性運動對骨質疏鬆症女性合併肌少症前期或肌少症之效益

The Benefits of Integrated Exercise Intervention in Osteoporotic Women with Pre-Sarcopenia or Sarcopenia

目的：骨質疏鬆症與肌少症是高齡社會重要健康議題，與跌倒、骨折有高度相關。惟過去研究少以兩者合併個案進行評估，且運動介入模式多為阻力訓練。研究目的為評估整合性運動對骨質疏鬆症女性合併肌少症前期或肌少症（四肢骨骼肌指數，skeletal muscle index, SMI低於5.7kg/m^2）之效益，以作為骨質疏鬆症合併肌少症照護之參考。方法：採準實驗設計，在區域型醫院招募24位骨質疏鬆症併有肌少症前期或肌少症之婦女為研究對象，分成實驗組與控制組。兩組均接受面對面之營養衛教模式；實驗組進行16週整合性中高強度阻力與敏捷性運動訓練（自覺強度維持6－8分），每週一次，每次120分鐘。評估訓練介入前、後組內之身體組成（體脂肪率、上下肢肌肉量）、肌少症指標（SMI、握力）及功能性體適能（上下肢肌力、動靜態平衡）之變化，並控制年齡以單因子共變數或無母數統計進行組間分析。結果：實驗組12位（63.1±7.7歲）與控制組12位（70.1±6.1歲），兩組除年齡外，在基本資料無明顯差異。組內分析，實驗組體脂肪率、上下肢肌肉量、SMI、握力與上肢肌力均顯著改善；而控制組之體脂肪率、軀幹、右腿與左腿肌肉量均顯著變差，上下肢肌力亦明顯退步。組間分析顯示實驗組相較控制組體脂肪率顯著降低，且SMI、握力、上肢肌力、及下肢肌力之變化量均顯著較控制組提升。兩組在動態及靜態平衡上無顯著差異。結論：合併阻力與敏捷性之整合性運動對骨質疏鬆症合併肌少症前期或肌少症之婦女的身體組成、肌少症指標及上下肢肌力表現有實質提升效益，而無介入運動模式下，控制組在16週內體脂肪率增加、肌力下降。未來經更多著重骨質疏鬆症合併肌少症之實證研究，此整合性運動訓練模式或可作為介入和照護方向參考。

Objective: Osteoporosis and sarcopenia are two important geriatric issues highly correlated with falls and frailty fractures in the elderly. Studies in the past rarely investigate the combined case of the two syndromes, and emphasis has been placed mainly on resistance training. This study aimed to investigate the benefits of integrated exercise interventions in osteoporotic women with pre-sarcopenia or sarcopenia (Skeletal Mass Index, SMI＜5.7 kg/m^2). Methods: Twenty-four osteoporotic women with pre-sarcopenia or sarcopenia were recruited from a regional hospital to participate in the quasi-experimental study. They were divided into an integrated exercise group (EG) and a control group (CG) with all participants receiving face-to-face nutrition education. The EG group was required to enroll in a 16-week moderate-to-vigorous intensity exercise program in resistance and agility training (Rating of Perceived Exertion maintained at 6-8 points). Each weekly session lasted for 120 minutes. Changes in body composition (body fat percentage, muscle mass), sarcopenia parameters (SMI, grip strength), and physical fitness (muscle strength, static and dynamic balance) before and after the integrated exercise intervention were analyzed with age as a covariate in the analysis. Results: Except for age, there was no significant difference in the basic characteristics between the EG (n=12; 63.1±7.7 years) and CG (n=12; 70.1±6.1 years) groups. Intragroup analysis showed a reduced body fat percentage , along with significant improvement in SMI, grip strength, and upper limb muscle strength in the EG group. In contrast, the CG group reported an increased body fat percentage, and a significant decrease in the muscle mass in the trunk and lower leg, as well as in the muscle strength in the upper and lower limbs. Intergroup analysis showed that the EG group experienced a significant improvement in body fat percentage, SMI, grip strength, and upper and lower limb muscle strength. There was no significant difference in the results of dynamic and static balance tests between the two groups. Conclusion: The integrated exercise intervention combined with resistance and agility training can substantially improve the body composition, sarcopenia parameters, and upper and lower limb muscle strength in osteoporotic women with pre-sarcopenia or sarcopenia. On the contrary, a significant increase in body fat percentage and a decrease in muscle strength in 16 weeks are likely to occur in the absence of the intervention. In the future, more empirical studies focusing on the combined case of osteoporosis and sarcopenia are needed, and the integrated exercise training in this study may serve as a reference for intervention.