荷重性運動是否增加更年期婦女骨質密度?Does weight-bearing exercise increase bone mineral density in menopausal women?

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2020-07-27 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

胡瑞桃* 余文彬 蔡依紋

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

婦產科與婦女健康 Obstetrics, Gynecology and Women's Health

科別

  • 護理領導 Nursing Leadership
  • 重症護理 Critical Care Nursing
  • 護理教育 Nursing Education

中文關鍵詞

荷重性運動、更年期婦女、骨質密度

英文關鍵詞

weight-bearing exercise menopausal women bone mineral density

機構名稱

長庚醫療財團法人基隆長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
骨質疏鬆症(Osteoporosis)是一種退行性及全身性骨骼疾病,主要為骨密度低及骨組織結構惡化,增加骨折風險(Going, 2003)。依世界衛生組織報告,30%停經後婦女患骨質疏鬆症(National Osteoporosis Foundation, 1999)。正常女性停經年齡為51歲,95%於45至55歲之間停經(Martin, & Barbieri, 2018)。骨質疏鬆症最常見臨床表現為髖部、椎骨或腕部骨折(Howe et al., 2011)。荷重性運動(Weight-bearing Exercise),每次持續60分鐘,持續6個月,每週3次,可降低骨質疏鬆症罹患的風險(Marchese et al., 2012)。停經更年期婦女,建議每週運動3次,每次至少30分鐘,增加骨密度(Bone Mineral Density, BMD) (Rosen & Drezner, 2018)。形成臨床問題-荷重性運動是否增加更年期婦女骨質密度? P:更年期婦女。I:荷重性運動。C:未接受荷重性運動。O:骨質密度。
文獻搜尋的方法與分析:
本文形成一個「PICO」問題,依據其同義字搜尋 Cochrane library、PubMed、Up To Date、Medline、DynaMed、中文電子期刊服務(Chinese Electronic Periodical Services, CEPS)及全國碩博士論文資訊網(Networked Digital Library of Theses and Dissertations, NDLTD)等資料庫進行搜尋。以 P、I、C、O 關鍵字,包括關鍵字(MeSH)及同義字(Synonyms),利用布林字元「OR」、「AND」、篩選以中文及英文語言進行資料搜尋。
文獻的品質評讀:
文獻搜尋結果,中英文文獻資料庫共62篇,其中扣除重複8篇、未符合PICO 40篇及沒有全文12篇,排除並刪除文獻後,共評讀2篇,包括系統性文獻回顧(Systematic Reviews, SR)及隨機分派研究臨床試驗(Randomized Controlled Trial, RCT)各1篇,以Critical Appraisal Skills Programme (CASP)最新版31.05.13版,進行系統性文獻回顧(SR)及隨機分派研究臨床試驗(RCT)評讀。
證據之臨床應用:
採實驗前趨性研究,透過與醫療團隊,包括婦產科醫師、復健科醫師、家醫科醫師、復健師及護理人員等成員協助,收案對象為社區更年期停經婦女門診追蹤病人,實驗組接受荷重性運動,包括支撐單腳站立、坐下至站立、踏板塊、向前弓步等運動訓練,由具有運動專業之物理治療師,於復健教室進行運動指導執行,每週3次,每次1小時,對照組則未接受任何荷重性或專家指導運動,於2018年8月10日至2019年6月1日止,共收案10個月。
成效評值:
共收案30人,包括實驗組及對照組各15人。統計檢定,包括描述性分析(Descriptive Analysis)、獨立t檢定(Independent Samples t Test)及配對t檢定(Paired t Test)等分析,以雙能量X光吸收儀(Dual Energy X-ray Absorptiometry, DXA)比較個案之T-score及骨質密度。結果顯示:(1)實驗組與對照組之平均年齡為65.13歲-65.27歲,身體質量指數(Body Mass Index, BMI)為20.94(kg/m2) -24.41(kg/m2)。(2)實驗組與對照組具同質性。(3)荷重運動介入後,實驗組與對照組T-score及骨質密度(g/cm2)之差異比較,實驗組較對照組於腰椎(T-score)值及左側股(T-score)值有改善,各達顯著差異(t=-2.191, p.=0.037)及(t=-2.541, p.=0.017)。(4)荷重運動介入後,實驗組後測較前測之腰椎(T-score)、腰椎(骨密度)、左側股骨(T-score)、右側股骨(T-score)及右側股骨(骨密度)之骨質密度(g/cm2)及T-score值,有顯著改善「不含左側股骨(骨密度)」。
結論與建議:
透過實證文獻查證及運用前驅性收案結果,著實回答主題-荷重性運動能增加更年期婦女骨質密度。限制方面,收案為門診個案,運動執行需透過專業治療師協助指導及空間考量,受限於人力及普遍化運動推展。建議方面,未來荷重性運動納入醫院員工健康促進訓練,同時將醫護人員納入參與相關課程訓練,以利個案運動指導普及化與同時利於臨床廣泛推動。另外,期望日後能將此有效荷重運動,納入此類個案生活型態之一部份。

英文摘要

Ask an answerable question (PICO):
Osteoporosis is a degenerative or systemic bone disease characterized by low bone mass and deterioration of bone tissue, which increases the risk of fracture (Going, 2003). According to the World Health Organization, 30% of postmenopausal women suffer from osteoporosis (National Osteoporosis Foundation, 1999). The age of menopause for normal women is 51 years old, and 95% of menopause is between 45 and 55 years old (Martin, & Barbieri, 2018). The most common clinical manifestations of osteoporosis are hip, vertebrae, or wrist fractures (Howe et al., 2011). Weight-bearing exercise training includes each lasting 60 minutes, lasting 6 months, and 3 times a week, which could reduce the risk of osteoporosis (Marchese et al., 2012). For menopausal women, it is recommended to exercise 3 times a week for at least 30 minutes each time to increase bone mineral density (BMD) (Rosen & Drezner, 2018). Forms a clinical question-does weight-bearing exercise increase bone mineral density in menopausal women? P: menopausal women. I: weight-bearing exercise. C: no weight-bearing exercise. O: bone mineral density.
The Method and Analysis of Literature Review:
The search method and analysis of literature review forms a "PICO" problem. Searching databases of the Cochrane library, PubMed, Up To Date, Medline, DynaMed, Chinese Electronic Periodical Services (CEPS), Networked Digital Library of Theses and Dissertations (NDLTD) based on the synonyms. In addition, use keywords of P, I, C, and O, which include MeSH, synonyms, Boolean characters "OR", "AND", and filter with Chinese and English to search literature review.
Critical Appraisal:
According to the results of literature review, there are total 62 articles with Chinese and English database, which including 8 articles are duplicated, 40 articles do not meet PICO, and 12 articles do not have full-text. After the articles are excluded and deleted, a total of 2 articles are reviewed, which include Systematic Reviews (SR) and Randomized Controlled Trial (RCT), respectively. The quality appraisal based on Critical Appraisal Skills Programme (CASP) with the latest version 31.05.13 to SR and RCT.
Clinical Application of Evidence:
This evidence application conducted experimental with pilot study. The medical team members included obstetricians and gynecologists, rehabilitation physicians, family physicians, physical therapists, and nursing staff. The subjects of the study were the community menopausal women and follow-up in the outpatient department (OPD). The experimental group received weight-bearing exercise, including single leg standing with support, sit to stand, step up, and forward lunge. The physical therapists educated the subjects for weight-bearing exercise 3 times a week and 1 hour each time in the rehabilitation classroom. The control group did not receive any load-bearing or expert-guided exercises. The study conducted from August 10, 2018 to June 1, 2019, a total of 10 months.
Evaluation of Effectiveness:
A total of 30 valid subjects were recruited, including 15 subjects in the experimental group and in the control group, respectively. Statistical analysis included descriptive analysis, independent samples t test, and paired t test. The T-score and bone density were compared before and after the weight-bearing exercise with Dual Energy X-ray Absorptiometry (DXA). The results showed that: (1) the average age of the experimental group and the control group was 65.13 to 65.27 years old, and the Body Mass Index (BMI) was 20.94 (kg/m2) -24.41 (kg/m2). (2) the experimental group and the control group were homogeneous. (3) T-score of the lumbar spine and left femur in the experimental group was improved after the weight-bearing exercise, reaching a significant difference (t=-2.191, p. =0.037) and (t=-2.541, p. =0.017), respectively. (4) after the weight-bearing exercise, the posttest compared with the pretest of experimental group on the lumbar spine (T-score), lumbar spine (bone density), left femur (T-score), right femur (T-score), and right femur (bone density), reaching a significant difference improved, except the left femur (bone density).
Conclusions and Recommendations:
Through evidence literature review and the pilot study results, the answer to the topic that weight-bearing exercise could increase bone density in menopausal women. In terms of limitation, the subjects were accepted as an outpatient department (OPD), the exercise needs to be guided by professional physical therapists and space considerations. Limited by the need for manpower and generalized exercise guidance. Therefore, the exercise is recommended that medical staff joining health promotion training would be included in the future. At the same time, medical staff will be included in relevant training courses to facilitate the popularization of exercise education and the widespread promotion of clinical practice. In addition, it is hoped that this effective weight-bearing exercise can be included as part of the lifestyle of such cases in the future.