血液透析患者身體活動量與相關因素探討
Physical Activity Level and Relative Factors Among Hemodialysis
Patients
中文摘要 本研究旨在了解血液透析患者的身體活動量，以及與基本屬性、疾病屬性、合併 慢性病情形、生理狀況、憂鬱與運動社會支持間的關係。採量性橫斷式 （cross-section）的研究設計，以大台北地區 212 位血液透析患者為研究對象， 以國際身體活動量表臺灣中文版、主觀式整體評估量表、貝氏憂鬱量表、運動社 會支持量表進行結構式問卷調查，研究資料以次數、百分比、平均值、標準差呈 現描述性統計，以曼-惠特尼檢定（Mann-Whitney U test）、克-瓦二氏單因子等級變異數分析（Kruskal-Wallis one-way analysis of variance by ranks）、Spearman 等 級相關係數（Spearman＇s rho correlation）、逐步迴歸分析（Stepwise regression） 進行推論性統計。 結果發現： 一、 本研究對象七日身體活動代謝當量為 5158.1 mins-MET／week，相對身體 活動量為 12.3 Kcal／Kg／day，絕對身體活動量為 697.5 Kcal／day。 二、本研究對象相對身體活動量在性別（Z = -2.712, p = .007）、婚姻狀況（X 2 = 8.419, p = .015）、合併糖尿病（Z = -2.494, p = .013）上有顯著差異，女性相對身 體活動量大於男性；未婚者相對身體活動量較已婚、離婚／喪偶者高，有合併糖 尿病者相對身體活動量小於無糖尿病者。 三、本研究對象相對身體活動量與運動社會支持（r = .234, p < .000）、主觀式整 體評估量表得分（r ＝ .337, p < .000）、血液尿素氮廓清率（r = .167, p = .015）、 血液尿素氮清除率（r = .155, p = .024）、副甲狀腺素荷爾蒙（r = .146, p = .034） 呈現正相關；與心肺比例（r =- .295, p < .000）、三酸甘油脂（r = - .143, p = .034）、 飯前血糖（r =- .180, p = .009）呈現負相關。 四、絕對身體活動量與運動社會支持(r = .245, p < .001)、主觀式整體評估量表得 分（r = .421, p < .000）、身體質量指數（r = .370, p < .000）、血清肌酸酐（r = .186, p = .007）、副甲狀腺素荷爾蒙（r = .141, p = .041）呈現正相關；絕對身體活動量 與心肺比例呈現負相關（r = - .334, p< .000）。 五、影響相對身體活動量的顯著預測因子為主觀式整體評估、婚姻狀況、運動社 會支持、心胸比例、性別、合併糖尿病，可以有效解釋身體活動量約 28.7％的變 異量。 本研究建議提早改善血液透析患者的營養狀況、對於心肺功能較差的患者，考慮 漸進式的運動模式，由低強度的活動開始，有計畫的來增加血液透析患者的身體 活動量；醫護人員可利用接觸血液透析患者的機會，多與患者討論運動的話題及 設計運動教育活動等，以提昇血液透析患者的身體活動量。
英文摘要
The purpose of this study was to investigate the physical activity level among hemodialysis patients, and to explore the associations among the basic attribute, disease attribute, combine chronic disease, physiological state, depressed status, social supports for exercise. The study was used to cross-section design. Four questionnaires including the International Physical Activity Questionnaire Version Self -
Administered Long Format (IPAQ), Subjective Global Assessment (SGA), The Beck Depression Inventory-Second Edition (BDI-II) and Social Supports for Exercise Scale were used in interviews and 212 hemodialysis patients participated in this study. Data were analyzed by frequency, percentage, mean, standard deviation, Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance by ranks, Spearman’s rank -
correlation, Stepwise regression.
The major findings of this study were follows:
1. The metabolic equivalent of the physical activity was 5158.1 mins-MET/week, relative amount of physical activity was 12.3 Kcal/Kg/day and absolute amount of physical activity was 697.5 Kcal/day.
2. This study finds sex (Z = -2.712, p = .007), marital status (X2 = 8.419, p = .015), combining diabetes mellitus (Z = -2.494, p = .013) have differences relative amount of physical activity level.
3. The relative amount of physical activity level significantly was positively
correlated with the social supports for exercise (r = .234, p < .001), SGA (r = .337, p < .000), Kt/V (r = .167, p = .015), Urea reduction ratio (r = .165, p = .024) and i-PTH (r = .146, p = .034). The relative amount of physical activity level significantly was negatively correlated with C/T ratio (r = - .295, p < .000), Triglyceride (r = - .143, p = .034) and AC sugar (r = - .180, p = .009)
4. Absolute amount of physical activity level significantly was positively correlated with the social supports for exercise (r = .245, p < .001), SGA (r = .421, p < .000), BMI (r = .370, p < .000), Serum creatinine (r = .186, p < .007) and i-PTH (r = .141, p = .041). The relative amount of physical activity level significantly was negatively correlated with C/T ratio (r = - .334, p < .000).
5. The SGA, marital status, the social supports for exercise, C/T ratio and sex and combining diabetes mellitus disease; explaining 28.7% variation respectively achieved in relative amounts of physical activity.
This research proposes improving the hemodialysis the patient's nutrition state and heart and lungs function is worse ahead of time, consider the progressive
activity that the hemodialysis the patient plan; The medical personnel can utilize and contact the chance that the hemodialysis patients, discuss the topic of the movement and design sport educational activities with patient more, in order to promote the physical activity that the hemodialysis patient.
