| 摘要: | 背景：冠狀動脈心臟病為全世界主要死亡原因之一。不運動的生活型態是冠狀動脈心臟病的危險因子之一。太極拳是我國傳統之武術或運動，研究證實太極拳對生活品質及生活功能有療效的部份，包括活動耐受性、心血管功能、疼痛治療、身體平衡與預防跌倒、提昇免疫功能、改善身體彈性、強度及Kinesthetic sense。 實驗方法：本臨床研究共61 名冠狀動脈心臟病患參與，依其意願分為兩組，太極拳組共22 名，對照組共39 名，太極拳組施以太極拳訓練，對照組鼓勵在家作輕度運動，兩組皆繼續原有藥物治療。六個月後，評估運動功能、血脂肪、自主神經功能、左心室收縮及舒張功能。 實驗結果顯示：體重、身體質量指數、腰圍、收縮壓、舒張壓及心率功能，兩組之間沒有顯著差異( p>0.05)。跑步機運動功能測試，結果亦顯示：運動中最高心率，太極拳組高於對照組，太極拳組0 個月與6 個月之間顯著下降，兩組之間存在顯著差異（p=0.033）。然而，運動前心率與收縮壓乘積(運動前雙產物)之數據顯示：對照組之數值高於太極拳組，兩組之間存在顯著差異（p=0.003）。運動中最高心率與最高收縮壓乘積(運動中最高雙產物)之數據顯示：太極拳組，0、6 個月有差異(p=0.009)，呈下降趨勢。對照組，組內無差異。以一般線性模式的重複量數 分析結果顯示，兩組的Peak RPP 改變，受試者內效應項的檢定(假設為球形)，0、3、6 個月間有交互作用(interaction) (p= 0.048)，代表太極拳組Peak RPP 的下降比對照組顯著。運動中最高心率與最高收縮壓乘積減運動前心率與收縮壓乘積(運動中最高雙產物與運動前雙產物之差值)之數據亦顯示：兩組之間存在顯著差異（p=0.028）。自主神經功能實驗結果顯示：太極拳組0 個月與6個月與對照組0 個月與6 個月之間自主神經功能無顯著差異（p>0.05）。比較太極拳運動前後與跑步機運動前後之自主神經功能之實驗數據：太極拳組運動3 個月後之心率變異性，平均RR 間期、SDNN、SDNNi、Total power、VLF power 顯著呈上升趨勢( p<0.05 )，而平均心率(Mean heart rate)明顯呈下降趨勢(p<0.01)。太極拳組在運動6 個月後之心率變異性，平均RR 間期、SDNNi、Total power、LF power、LF/HF 與nLF 顯著呈上升趨勢( p<0.05 )，而平均心率與nHF 顯著呈下降趨勢(p<0.05) 。太極拳組在跑步機運動後，平均心率上升，而心率變異性無顯著差異。對照組在跑步機運動後，平均心率上升，LF power 上升，而其他心率變異性無顯著差異。分析血液中三酸甘油脂、高密度脂蛋白膽固醇、總膽固醇與高密度脂蛋白膽固醇比值、血糖、尿酸、肌酸酣與高敏感性C 反應蛋白等功能，比較太極拳實驗組與對照組之檢驗結果顯示無顯著差異（p>0.05）。總膽固醇與低密度脂蛋白膽固醇，0、3，0、6 個月間有顯著差異，呈下降趨勢，以一般線性模式的重複量數分析結果顯示，兩組的總膽固醇與低密度脂蛋白膽固醇改變，受試者內效應項的檢定(假設為球形)，0、3、6 個月間有交互作用(interaction)（p=0.027, 0.019），代表太極拳組總膽固醇與低密度脂蛋白膽固醇的下降比對照組顯著。檢查心臟超音波，左心室等容積鬆弛時間(Isovolumicrelaxation time)、舒張早期左心室充填速度E 波、心房收縮造成舒張晚期左心室充填速度A 波、E 波最高振幅減速時間(Deceleration time)、E 波與A 波比值、心室收縮期肺靜脈波血流 速度S 波與心室舒張期肺靜脈波血流速度D 波、左心室射出分率、左心室舒張末期容積、左心室收縮末期容積等功能，比較太極拳實驗組與對照組之檢驗結果顯示無顯著差異（p>0.05）。 結論：運動中最高心率，太極拳組高於對照組，太極拳組0 個月與6個月之間顯著下降，兩組之間存在顯著差異。運動中最高心率與最高收縮壓乘積，太極拳組0 個月與6 個月之間呈下降趨勢，與對照組有顯著差異。運動中最高心率與最高收縮壓乘積減運動前心率與收縮壓乘積，太極拳組0 個月與6 個月之間顯著下降，與對照組兩組之間存在顯著差異。顯示太極拳運動訓練，降低運動中心肌氧氣需求，提高運動中心肌缺血閥值。次極度跑步機運動試驗為高強度運動，運動後30 分鐘則僅使運動後兩組之平均心率上升，對照組之LF power 上升，太極拳組無變化，可能因高強度運動使自主神經恢復較慢有關。中強度太極拳運動後30 分鐘平均心跳率下降，心率變異值上升，顯示中強度太極拳運動使自主神經恢復較快，心率變異總能量上升，交感、副交感神經之調控得到改善，對運動後短期副交感再活化較次極度跑步機運動提早。太極拳組總膽固醇與低密度蛋白膽固醇的下降比對照組顯著。
Background: Coronary artery disease is a leading cause of death worldwide. Physical inactivity is one of the risk factors of coronary artery disease. Tai Chi Chuan (TC) is a traditional Chinese martial art and exercise. Accumulated evidences were found to confirm the therapeutic benefits of TC exercise with regard to quality of life, physical function including activity tolerance and cardiovascularfunction, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Methods: A total of 61 subjects with coronary artery disease, defined as more than 50 percent stenosis in diameter or 75% stenosis in area by angiography, were enrolled. Twenty-two subjects received TC exercise training and 39 subjects continued their daily physical activity. Treadmill exercise test, lipid profiles, heart rate variability and systolic and diastolic function of the left ventricle were evaluated at baseline, 3 months and, 6 months. Results: There was no significant difference on body weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, resting heart rate between the two groups. On treadmill exercise test, peak heart rate during exercise at baseline decreased after 6 months of TC. The decrement was significantly different from that of controlled group (P=0.033). The pre-exercise rate pressure product of controlled group was significantly higher than the TC group (P= 0.028). The peak rate pressure product of the TC group was significantly decreased between baseline and 6 month. The within-subjects effect (sphericity assumed) was significantly different between two groups (p=0.048). There was interaction between TC and controlled group. The decrement of peak rate pressure product of TC group was significantly different from that of controlled group. The difference between peak and pre-exercise rate pressure product also decreased in the TC group after 6 months of exercise, significantly different from the controlled group (p= 0.028). Resting heart rate variability was no significant difference between two groups. Heart rate variability before and post-Texercise showed decreased mean heart rate, increased SDNN, SDNNi, total power, VLF power on 3 months and decreased mean heart rate, nHF, increased SDNNi, total power, LF power, LF/HF,nLF on 6 months. Heart rate variability before and post-treadmill exercise test showed increased mean heart rate on two groups and increased LF power on control group. Triglyceride, HDL-cholestrol, cholesterol/HDL-C, creatinine, glucose, uric acid, hs-CRP were not significantly different between the two groups. Total cholesterol and LDL-cholesterol decreased significantly between 0, 3 and 0, 6 months in TC group. The within-subjects effect (sphericity assumed) was significantly different between two groups (p=0.027, 0.019). There was interaction between two groups. The decrement of total cholesterol and LDL-cholesterol of the Tai Chi group was significantly different from that of control group. Isovolumic relaxantion time, E wave velocity, A wave velocity, E/A ratio, deceleration time of E wave, S wave and D wave of pulmonary flow, ejection fraction, left ventricular end diastolic volume, left ventricular end systolic volume were no significant differences between two groups. Conclusion: The peak heart rate during treadmill exercise decreased after 6 months of TC. The decrement of peak heart rate was significantly different from that of controlled group.The peak rate pressure product of the TC group was significantly decreased between baseline and 6 month. The decrement of peak rate pressure product of TC group was significantly different from that of controlled group. Thedifference between peak and pre-exercise rate pressure product also decreased in the TC group after 6 months of exercise, significantly different from the controlled group. TC decreased O2 consumption during exercise at the same intensity and duration of exercise. Comparing TC with treadmill exercise test, heart rate decreasedsignificantly after TC 30 minutes and increased significantly after treadmill exercise test. Heart rate variability increased post-TC, but not post-treadmill exercise test. TC had a quicker restoration of vagalmodulation than treadmill exercise test after termination of exercise. The decrement of total cholesterol and LDL-cholesterol of the Tai Chi group was significantly different from that of control group. |
