不同阻力之下肢推蹬運動對退化性膝關節炎患者訓練效果之探討

Abstract

摘要

退化性膝關節炎患者常因疼痛、肌肉功能受損及本體感覺變差而產生下肢功能障礙。文獻報告顯示阻力運動能改善此類患者的肌肉功能，閉鎖鏈運動對於關節本體感覺之敏感度有加強效果。雖然有學者認為較高阻力之訓練仍適用於退化性膝關節炎患者，但過去之研究多傾向以低阻力訓練為主，因此本研究之目的在探討高阻力與低阻力之下肢推蹬運動訓練對改善退化性膝關節炎患者膝功能障礙、膝部肌力、膝關節角度配對誤差值與行走速度之差異。方法：受試者選取輕至中度退化性膝關節炎之患者，隨機分成兩組，完成實驗者低阻力組(10﹪~ 25﹪體重)有22人，高阻力組(50﹪~ 65﹪體重)有21人。實驗前評估兩組患者的班第膝功能障礙指數、膝關節主動－主動角度配對誤差值、四種情況（直線行走60公尺、海綿墊上、往返一次上下樓梯、8字型路徑行走）之最快行走速度、三種角速度（600/秒、1200/秒、1800/秒）之等速肌力最大力矩值；統計之顯著值定為p＜ .05。結果：經過8週之下肢推蹬運動訓練，兩組的班第膝功能障礙指數均有明顯降低且達統計水準值， p＜ .05。膝關節主動－主動角度配對誤差值只在高阻力組有顯著進步並達統計水準值p＜ .05，低阻力組則無p= .07。兩組之最快行走速度除高阻力組之60公尺直線行走速度外，都有明顯進步且達統計差異p＜ .05。三種角速度之患側膝伸肌最大力矩值，以高阻力組進步較明顯達到統計上之顯著差異p＜ .05，三種角速度之患側膝屈肌最大力矩值以低阻力組增加較多p＜ .05。結論：下肢推蹬運動訓練能有效改善退化性膝關節炎患者班第膝功能障礙指數、膝部肌力、膝關節主動－主動角度配對誤差值及行走速度。低阻力組之下肢推蹬運動訓練在改善長距離之行走功能明顯較好，而高阻力組對於8字型行走速度及膝關節主動－主動角度配對誤差之訓練效果比較顯著。

Abstract Patients with osteoarthritic knees are often disabled due to symptoms such as pain, muscle weakness, and impairment of knee proprioception. Previous studies showed that resisted exercises could significantly improve muscular function of those patients and closed kinetic chain exercises have great benefits for joint proprioception. An important determinant in prescribing resisted exercise is weight. Numerous studies have shown that low resistance is a popular method, although the ACSM suggested a higher resistance training program. The purpose of the present study was to compare effects of leg press exercise with different resistance levels in patients with osteoarthritic knees. Method：43 patients with mild to moderate OA knees were randomized into low resistance (n=22) or higher resistance group(n=21). The following variables were assessed before and after the training program for all subjects；(1)Bandi’s functional incapacity score of the osteoarthritic knee.(2)Isokinetic peak torque of knee extensor and flexor；(3)knee joint active-active reposition sense(4)the fastest walking speed of level walking, sponge walking, figure of 8, up and down stairs. An ρevel of .05 was used to test for statistical significance. Results：Knee joint active-active reposition sense improved after training in the higher resistance group. Both groups had significant improvement in the fastest walking speed of all conditions, except for level walking in the higher resistance group. There is a significant increase in the percent change of knee extension torque in the higher resistance group and flexion torque in the low resistance group after 8 weeks of training. Conclusion：The results of this study showed that the leg press exercise is an effective therapeutic exercise for mild to moderate osteoarthritic knees. The low resistance group had significantly better score than the higher resistance group in level walking speed. The higher resistance group had significantly better score than the low resistance group in figure of 8 walking speed and knee joint active-active reposition sense.