台灣人口結構正經歷顯著高齡化轉型，老年人口65歲以上占比接近總人口20%門檻，將造成超高齡社會型態。此現象伴隨「健康餘命」與「失能存活期」的雙重延展效應，個體從亞健康狀態、衰弱症前期（Pre-frailty）、臨床衰弱期（Frailty）至生命終末期的病程軌跡顯著拉長。當長者進入功能衰退階段時，將面臨多重層面的惡性循環：下降的基礎代謝率導致肌少症風險、社交退縮加速認知功能退化、慢性病共病性更形複雜，最終形成失能失智的複合性健康危機。此連鎖效應不僅衝擊醫療照護體系，更衍生龐大社會成本，故建構有效預防性介入模式，已成為當今公共衛生的領域亟待突破的核心課題。
在衛生福利部的「高齡友善城市計畫」政策框架下，全台已布建逾3,000處社區關懷據點，系統性推動包含體適能課程、認知訓練模組及社會參與方案等多元介入措施。然實務執行面臨雙重困境：其一，COVID-19疫情後遺症導致實體課程參衰退，數位轉型需求迫切；其二，專業人力受地理限制，偏鄉地區獲得的服務密度遠不如都會區，形成健康不平等結構。為突破現有框架，本論文研究創新設計一套以骨架追蹤技術的基礎並結合自行設計之舞蹈式健康促進運動的之虛擬實境（VR）健康促進系統，探討其應用於社區長者健康促進的效益與可行性。
本研究採兩階段驗證模式：第一階段是針對社區居住長者，設計並建置一套以骨架追蹤技術的基礎之虛擬實境運動系統，以評估其可行性與信度。該系統整合微軟開發之 Kinect 體感裝置與腕戴式脈搏血氧儀，運動內容包含有氧運動、肌力運動及伸展運動三大類型。研究以20位社區長者為對象，檢驗系統的同時效度、再測信度與可行性。結果顯示，各類型運動的再測信度無論是在有即時骨架追蹤與否系統都可達中等至良好水準（ICC= 0.749–0.968），運動強度分級與心律的同時效度顯示 (0.859-0.945)。就問卷結果而言，有即時骨架追蹤組在自主練習意願、即時運動動機與安全感知方面表現均優於無骨架（p< 0.05），且未來參與意願亦顯著比較高（80% vs. 60%，p = 0.001）。
第二階段採隨機對照試驗設計，共招募 64 位社區老年人參與，隨機分為對照組與實驗組。實驗組採用骨架追蹤虛擬實境運動的系統進行訓練，對照組則是進行傳統有氧運動影片訓練，訓練每週三次，為期八週，之後於第12周追蹤。結果顯示，兩組參與者在第 0–8 週及第 0–12 週期間之椅子站立測驗與六分鐘步行測驗表現均有顯著提升，惟實驗組於椅子站立測驗（0–8 週）及六分鐘步行測驗（0–12 週）的改善幅度顯著優於對照組。同時，實驗組在世界衛生組織生活品質問卷（WHOQOL-BREF）之 0–8 週與 0–12 週評量中，亦顯示出顯著進步。
本論文研究完成了一套以骨架追蹤技術的基礎並結合自行設計之舞蹈式健康促進運動的之虛擬實境（VR）健康促進系統，並驗證其具有良好的可行性與介入效益。此系統不僅能有效提升社區衰弱前期長者的運動強度與參與度，亦能增進其運動動機與生活品質。與傳統運動模式相比，結合 Kinect 系統之骨架追蹤有氧舞蹈訓練更能促進社區衰弱前期長者之身心健康，達到延緩衰弱、促進成功老化與健康老化之目標。

Taiwan's population structure is undergoing a significant aging transition, with the proportion of people aged 65 and above approaching 20% of the total population, leading to a super-aged society. To shorten the prefrailty interval and develop effective preventive intervention models has become a core issue in contemporary public health. The purposes of this dissertation were to develop an innovative virtual reality (VR) health promotion system which is based on skeleton tracking technology and combined with self-designed dance-based health promotion exercises and to explore its feasibility and effectiveness in promoting health among the community-dwelling older adults.
This study was conducted in two phases. In the Phase I, a VR exercise system based on skeletal tracking technology was designed and implemented for community-dwelling elderly individuals. The system integrated a Microsoft Kinect sensor and a wrist-worn pulse oximeter, providing three types of exercise: stretching, strengthening, and aerobics. Twenty older adults were recruited to assess the system’s reliability and feasibility. The results showed the test-retest reliability across all exercise models were moderate to good level (0.749–0.968) in both Display Skeletal group and No Display Skeketal group, indicating the consistency of the system. The concurrent validity for exercise intensity grading and heart rate was (0.859–0.945). Regarding the questionnaire results, the Display Skeleton group performed better than the No Display Skeleton group in terms of willingness to practice independently, immediate motivation for movement, and safety perception (p < 0.05), and also had a significantly higher willingness to participate in the future (80% vs. 60%, p = 0.001). In Phase II, a randomized controlled trial was conducted with 64 older adults assigned to either an experimental group (Display Skeleton group) or a control group (No Display Skeleton group). The intervention was 3 session/wk, for 8 weeks. Both groups improved in the chair stand test and six-minute walk test (6MWT) at 0–8 and 0–12 weeks. However, the Display Skeleton group achieved significantly greater gains in chair stand performance at 0–8 weeks and in 6MWT distance at 0–12 weeks. Additionally, participants in the experimental group reported significant improvements in all domains of the WHOQOL-BREF at both time points.
This dissertation has developed a VR health promotion system based on skeleton tracking technology and integrated with a self-designed dance-based health-promoting exercise program, demonstrating its feasibility and effectiveness. Compared with traditional exercise programs, aerobic dance training using a VR health promotion system based on the Kinect system demonstrated greater benefits in exercise intensity, motivation, physical function, and quality of life, providing a promising strategy to promote health and successful aging in community-dwelling older adults.

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