研究目的：隨著年齡增長，老年人的認知功能與姿勢雙重作業控制能力容易受到前額葉皮質退化的影響，進而提高跌倒風險。血流限制訓練（blood flow restriction, BFR）作為一種低強度、低風險的運動策略，可提升老年族群在運動中參與執行功能相關活動的意願。先前研究指出，結合下肢BFR與跑步機行走訓練能即時改善年長者的執行功能與姿勢雙重作業表現，並提升心率變異性（heart rate variability, HRV）。本研究延續上述成果，進一步探討單次上肢BFR結合上肢踏車運動對老年人認知功能與姿勢雙重作業表現的即時效應。
方法：本研究共招募28名老年人（平均年齡 69.0 ± 3.2 歲，男性13名，女性15名）參與，採隨機交叉設計進行兩次間隔一個月的實驗。14位受試者先進行血流限制（BFR）結合上肢踏車運動，之後再執行未加壓的上肢踏車運動；另14位受試者則以相反順序進行相同的實驗流程。在 BFR 條件下，將加壓綁帶至於上臂，並加壓至每位參與者收縮壓的 80% 以限制靜脈回流。兩組都進行了上肢踏車運動，男性強度為 15 瓦，女性強度為 10 瓦，共進行三次，共 21 分鐘。所有受試者於每次運動介入前後皆接受前後測，包括認知功能測驗（Trail Making Test, TMT）與姿勢雙重作業表現評估（Posture Dual Task）。訓練前後的標準化差異計算方式為：（後測值 − 前測值）／前測值。
研究結果：在姿勢雙重作業任務中，拍擊反應燈反應時間於兩種情況內皆顯著下降（BFR情況：p < 0.01；控制情況：p < 0.01），但兩情況間標準化差異無顯著差異（p = 0.997）。拍擊數量於兩種情況內皆顯著上升（BFR情況：p < 0.01；控制情況：p < 0.01），但兩情況間標準化差異無顯著差異（p = 0.382）。正確拍擊率方面，BFR情況於介入後有正確率顯著提升（p < 0.01），控制情況僅有邊緣顯著差異（p = 0.091），然而兩情況間之標準化差異未達顯著（p = 0.348）。足底壓力中心移動面積（COP_Area）僅有BFR情況在訓練後呈現顯著下降情形（p = 0.01），BFR情況之標準化差異同時顯著小於控制情況（BFR情況: -9.44 ± 24.33%, 控制情況: 4.22 ± 20.61%, p = 0.004）。足底壓力中心移動前後方向的均方根(RMS)在兩情況內皆未達顯著差異（BFR情況：p = 0.151；控制情況：p = 0.523），兩情況之間差異亦不顯著（p = 0.207）；足底壓力中心左右方向之RMS在BFR情況內顯著下降（BFR情況：-10.15 ± 17.76%, p < 0.01），在控制情況內則顯著上升 (控制情況: 5.99 ± 13.52%, p = 0.016)，兩情況間標準化差異亦達顯著水準（p < 0.001）。在認知測驗方面，TMT Part A完成時間僅控制情況內有顯著下降（p < 0.01），BFR情況則未達顯著（p = 0.217）。TMT Part B兩情況完成時間皆呈顯著下降（BFR情況: p< 0.01；控制情況: p < 0.01），但兩情況間之標準化差異並不無顯著（p = 0.668）。在Part B與Part A的完成時間差值(TMT-B–A)，於兩種情況皆顯著下降 (BFR情況: p= 0.004；控制情況: p= 0.002 )；相較於控制情況，BFR情況在Part B與Part A兩種情況的完成時間差值的標準化差異顯著下降(p= 0.007)。
結論：老年人進行單次上肢BFR結合上肢踏車運動後，在姿勢雙重作業中的姿勢控制表現優於未加壓的上肢踏車運動。此外，上肢BFR結合運動亦展現部分提升認知功能的效應。綜合而言，本研究結果支持上肢BFR訓練可作為一項具潛力的介入策略，特別適用於下肢暫時活動受限的老年族群，有助於提升姿勢雙重作業表現與執行功能，對預防跌倒及促進認知健康具有潛在臨床應用價值。

關鍵詞：血流限制結合上臂踏車運動、姿勢雙重作業任務、路徑描繪測試

Degeneration of the prefrontal cortex in older adults may impair their performance in postural dual-task situations. This study investigated whether blood flow restriction (BFR) combined with upper limb arm ergometry could enhance executive function and postural control in older adults.
A total of 28 older adults (69.0 ± 3.2 years old; 13 males and 15 females) participated in the study. Each participant completed both the BFR and control conditions in a randomized order, with a one-month interval between sessions.
In the BFR condition, pneumatic cuffs were applied to the participants' upper arms and inflated to 80% of their systolic blood pressure to restrict venous return. In both conditions, participants performed upper limb ergometer exercises—15 watts for males and 10 watts for females—across three sets, totaling 21 minutes.
The results showed that compared to the control group, the combination of BFR and arm ergometry effectively reduced the center of pressure area and improved postural sway consistency. In terms of cognitive performance, both groups demonstrated significant improvements in the more complex task (Trail Making Test Part B), but the BFR group showed greater improvement in the completion time difference between Part A and Part B (TMT-B–A), indicating a more pronounced enhancement in executive function.
In conclusion, BFR combined with upper limb ergometry can improve postural stability and executive function in older adults. This approach shows clinical potential and may serve as an effective strategy for fall prevention.

Key words: Blood flow restriction, Arm ergometry, Postural Dual-task, Trail Making Test.

INTRODUCTION
With aging, cognitive decline linked to prefrontal cortex degeneration can impair dual-task control and increase fall risk in older adults. Blood flow restriction (BFR) combined with upper limb arm ergometry offers a low-intensity exercise option that may promote physical activity in this population. While most BFR research has focused on muscle strength and hypertrophy, recent studies show that lower limb BFR with treadmill walking can immediately enhance postural dual-task performance, cognitive function, and heart rate variability in older adults. However, it remains unclear whether similar benefits extend to upper limb BFR exercise. This study therefore investigated whether a single session of BFR combined with upper limb arm ergometry could improve postural dual-task performance and cognitive function in older adults.

MATERIALS AND METHODS
Twenty-eight older adults (mean age = 69.0 ± 3.2 years; 13 males, 15 females) participated in the study. Participants were randomly assigned to two groups and completed two experimental sessions one month apart. Fourteen participants first underwent blood flow restriction (BFR) combined with upper limb arm ergometry (BFR condition), followed by a control session without BFR. The other 14 participants completed the sessions in reverse order.In the BFR condition, pneumatic cuffs were applied to the upper arms and inflated to 80% of each participant’s systolic blood pressure to restrict venous return. Both groups performed upper limb ergometry at an intensity of 15 watts for males and 10 watts for females, across three bouts totaling 21 minutes. The postural dual-task required participants to stand on a soft foam and respond to visual target signals by tapping as quickly as possible. Outcome measures included reaction time (ms), number of correct taps, and error rate. Cognitive performance was assessed using the Trail Making Test, recording reaction time (ms). Functional and physiological improvements were quantified as normalized changes: (post-test − pre-test) / pre-test.

RESULTS AND DISCUSSION
In the postural dual-task condition, reaction time to the light-tapping task was significantly decreased within both conditions (BFR condition: p < 0.01; control condition: p < 0.01), although the between-condition difference in normalized change was not significant (p = 0.997). Hit number was significantly increased within both conditions (BFR condition: p < 0.01; control condition: p < 0.01), although the between-condition difference in normalized change was not significant (p = 0.382). Regarding tapping accuracy, the BFR condition showed a significant post-intervention improvement (p < 0.01), while the control condition showed a marginally significant change (p = 0.091); however, the between- condition difference in normalized change was not significant (p = 0.348). For center of pressure area (COP_Area), only the BFR condition demonstrated a significant reduction after the intervention (p = 0.01), and the normalized change was significantly greater in the BFR condition compared to the control condition (BFR: −9.44 ± 24.33%; control: 4.22 ± 20.61%; p = 0.004). In the anterior-posterior direction, the root mean square (RMS) of center of pressure sway did not show significant within-condition differences (BFR condition: p = 0.151; control condition: p = 0.523), nor was there a significant between-condition difference (p = 0.207). In the medial-lateral direction, the BFR condition showed a significant within-condition decrease in RMS (−10.15 ± 17.76%, p < 0.01), while the control condition exhibited a significant increase (5.99 ± 13.52%, p = 0.016), with a significant between-condition difference in normalized change (p < 0.001). In terms of cognitive testing, only the control condition showed a significant reduction in completion time on the Trail Making Test Part A (p< 0.01), while the BFR condition did not (p = 0.217). For Part B, both conditions demonstrated significant reductions in completion time (BFR condition: p < 0.01; control condition: p < 0.01), but the between-condition difference in normalized change was not significant (p = 0.668). The difference in completion time between Part B and Part A (TMT-B–A) significantly decreased under both conditions (BFR condition: p= 0.004; control condition: p= 0.002). The standardized difference in reaction time (TMT-B–A) was significantly decreased in the BFR condition compared to the control condition (p= 0.007).

CONCLUSION
The findings suggest that upper limb arm ergometry combined with blood flow restriction (BFR) improves postural dual-task performance and Trail Making Test Part B outcomes in older adults. These enhancements may reflect greater flexibility in cognitive resource allocation. Overall, the results support the potential of upper limb BFR exercise to enhance cognitive and dual-task performance, contributing to fall prevention in the aging population.

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