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研究生：	李欣曄 Lee, Hsin-Yeh
論文名稱：	高齡慢性腎臟病患者進行八週離心腳踏車運動訓練對體適能、心肺功能、腎功能和生活品質的影響 The Effects of Physical Fitness, Cardiopulmonary Function, Renal Function and Quality of Life Under Eight-weeks Eccentric Cycling Exercise Training in Older Patients with Chronic Kidney Disease
指導教授：	蔡昆霖 Tsai, Kun-Ling
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2023
畢業學年度：	111
語文別：	英文
論文頁數：	93
中文關鍵詞：	慢性腎臟病、離心腳踏車、體適能、心肺功能、腎功能、生活品質
外文關鍵詞：	Chronic kidney disease, Eccentric cycling, Physical fitness, Cardiopulmonary function, Renal function, Quality of life
相關次數：	點閱：255 下載：28
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背景
慢性腎臟病（CKD）是指腎絲球過濾率低於60毫升/分鐘/1.73平方米，持續三個月或以上。由於CKD的病理機制會導致許多共病症及體能上的衰弱，造成不良的預後。在過去研究指出，除了常規的腎臟治療，運動也被認為對CKD患者有益。現在有新型的運動為離心腳踏車，此運動方式的優勢為透過離心收縮的特性，幫助CKD患者在運動中減輕負擔及帶來更好的收益。然而，目前仍尚未有直接的研究顯示離心腳踏車運動訓練對於CKD患者的效益。本研究目的為探討八周的離心腳踏車運動訓練對於高齡慢性腎臟病患者的體適能、心肺功能、腎功能、生活品質等相關成效。
方法
本研究收入22位高齡慢性腎臟病患者將其隨機分配至控制組、向心腳踏車組、離心腳踏車組。向心腳踏車組、離心腳踏車組分別會接受為期八周、每周三次的運動訓練，控制組則接受常規衛教。探討運動訓練對於高齡慢性腎臟病患者的體適能、心肺功能、腎功能、生活品質之成效，研究數據進行組間與組內比較。
結果
經過八週的運動訓練後，觀察到離心腳踏車運動可以幫助患者降低體重、身體質量指數和體脂肪。同時，離心腳踏車也可以提高肌肉力量和骨骼肌率，改善患者的功能性活動能力、肺功能及生活品質。最後，本研究指出，離心腳踏車運動可能對慢性腎臟疾病患者的腎功能有所幫助。
結論
研究顯示，對慢性腎臟病患者進行八週的離心腳踏車運動訓練具有正面效益，而且沒有任何負面影響，表明了離心腳踏車是個可行且有效的運動

Background:
Chronic kidney disease (CKD) is defined as a glomerular filtration rate less than 60 mL/min/1.73 m2, persisting for three months. The pathological mechanisms of CKD can lead to many comorbidities and physical frailty, resulting in poor prognosis. Previous studies have suggested that exercise is beneficial for CKD patients in addition to conventional kidney treatments. A new type of exercise, eccentric cycling, has emerged and is advantageous due to its eccentric contraction property, which helps CKD patients to reduce burden and gain better benefits during exercise. However, there is still no direct evidence to demonstrate the efficacy of eccentric cycling exercise training for CKD patients. The aim of this study was to investigate the effects of an eight-week eccentric cycling exercise training program on physical fitness, cardiopulmonary function, renal function, and quality of life in elderly CKD patients.
Methods:
Twenty-two elderly CKD patients were randomly assigned to the control group, concentric cycling group, or eccentric cycling group. The concentric cycling group and eccentric cycling group received three exercise training sessions per week for eight weeks, while the control group received conventional health education. The effects of exercise training on physical fitness, cardiopulmonary function, renal function, and quality of life in elderly CKD patients were investigated, and the study data were compared between groups and within groups.
Results:
After eight weeks of exercise training, it was observed that eccentric cycling exercise could help patients reduce body weight, body mass index, and body fat. Moreover, eccentric cycling also increased muscle strength and skeletal muscle rate, improved patients' functional capacity, pulmonary function, and quality of life. Finally, this study suggested that eccentric cycling exercise might help improve renal function in patients with CKD.
Conclusion:
The results of this study showed that an eight-week eccentric cycling exercise training program had positive effects on CKD patients, and there were no negative impacts, indicating that eccentric cycling is a feasible and effective exercise.

摘要 I
ABSTRACT II
致謝 IV
ABBREVIATION V
CHAPTER 1 INTRODUCTION 1
1-1	Definition of Chronic kidney disease 1
1-2	Mechanism of CKD 1
1-3	Treatment of CKD 2
1-4	CKD associated with muscle wasting 3
1-5	CKD associated with cardiovascular disease 4
1-6	CKD associated with lung dysfunction 5
1-7	Exercise in CKD 5
1-8	Eccentric exercise training 7
1-9	Purpose of study 8
CHAPTER 2 MATERIALS AND METHODS 9
2-1	Study design 9
2-2	Study participants 9
2-3	Procedure 10
2-4	Cycling exercise training 10
2-5	Cardiopulmonary exercise test 10
2-6	Pulmonary function 11
2-7	Respiratory muscle strength 11
2-8	Diaphragm ultrasonography 12
2-9	Body composition 13
2-10  Muscle strength (grip strength and knee extensor strength) 13
2-11  Functional capacity (six-minute walking test and time up and go test) 14
2-12  Flexibility (chair sit and reach test) 14
2-13  36-Item short-form survey 15
2-14  Kidney disease and quality of life 15
2-15  Laboratory examination (renal function) 16
2-16  Outcome measurements 16
2-17  Statistical analysis 16
CHAPTER 3 RESULTS 18
3-1	Demographic and clinical characteristics 18
3-2	Body composition 18
3-3	Lower extremities Flexibility 20
3-4	Muscle strength 20
3-5	Functional capacity  22
3-6	Cardiopulmonary exercise test 23
3-7	Pulmonary function test	26
3-8	Respiratory muscle strength 26
3-9	Diaphragm ultrasonography 27
3-10  Quality of life (SF-36) 28
3-11  Quality of life (KDQOL) 30
3-12  Renal function 31
CHAPTER 4 DISCUSSION 34
4-1	Eccentric exercise reduces body weight, BMI, and body fat 34
4-2	Eccentric exercise improves muscle strength and skeletal muscle rate 35
4-3	Exercise improves functional capacity 36
4-4	Exercise improved exercise capacity (VO2) 36
4-5	Eccentric exercise improves pulmonary function and respiratory muscle 37
4-6	Exercise had a positive effect on the quality of life 38
4-7	Eccentric exercise had a positive effect on renal function 39
4-8	Limitations of this study 39
CHAPTER 5 CONCLUSIONS 41
REFERENCE	42
TABLES	47
Table 1. Demographic and clinical characteristic of CTL, CON and ECC group  47
Table 2. Body composition 49
Table 3. Physical fitness 50
Table 4. Cardiopulmonary exercise testing (CPET) 51
Table 5. Pulmonary function and respiratory muscle 53
Table 6. SF-36 55
Table 7. KDQOL 57
Table 8. Lab data 58
FIGURES 60
Figure 1. Study flow chart 60
Figure 2. Body fat of CTL, CON and ECC at 1st month and 2nd month 61
Figure 3. Skeletal muscle rate of CTL, CON and ECC at baseline, 1st month and 2nd month 62
Figure 4. Left knee extensor strength of CTL, CON and ECC at baseline, 1st month and 2nd month  63
Figure 5. Right knee extensor strength of CTL, CON and ECC at baseline, 1st month and 2nd month  64
Figure 6. Time up and go test of CTL, CON and ECC at baseline, 1st month and 2nd month 65
Figure 7. Six-minutes walking test of CTL, CON and ECC at baseline, 1st month and 2nd month 66
Figure 8. Maximum workload (watt) at VO2 maximal intensity of CTL, CON and ECC at baseline, 1st month and 2nd month 67
Figure 9. VO2 at VO2 maximal intensity of CTL, CON and ECC at baseline, 1st month and 2nd month 68
Figure 10. Predicted value of FVC of CTL, CON and ECC at baseline, 1st month and 2nd month 69
Figure 11. Diaphragm excursion of CTL, CON and ECC at baseline, 1st month and 2nd month 70
Figure 12. Creatine of CTL, CON and ECC at baseline and 2nd month 71
Figure 13. GFR of CTL, CON and ECC at baseline and 2nd month 72
Figure 14. Stationary bicycle for concentric and eccentric cycling training (750R) 73
Figure 15. Cardiopulmonary exercise test (Ultima CPX, MGC, US) 73
Figure 16. Pulmonary function test (microQuark, COSMED, Italy) 74
Figure 17. Maximal respiratory pressure (GB60, JITTO, Taiwan) 74
Figure 18. Ultrasound machine (ACUSON NX3 Elite, siemens Healthineers, Germany) 75
Figure 19. Body composition meter (Karada Scan 214, OMRON, Japan) 75
Figure 20. Grip strength measurement (Jamar hydraulic hand dynamometer) 76
Figure 21. Knee extensor strength measurement (microFET®2) 76
Figure 22. RPE scale rate from 6-20 77
Figure 23. 36-Item Short Form Survey part 1 78
Figure 24. 36-Item Short Form Survey part 2 79
Figure 25. 36-Item Short Form Survey part 3 80
Figure 26. 36-Item Short Form Survey part 4 81
Figure 27. 36-Item Short Form Survey part 5 82
Figure 28. 36-Item Short Form Survey part 6 83
Figure 29. Kidney Disease Quality of Life part 1	84
Figure 30. Kidney Disease Quality of Life part 2	85
Figure 31. Kidney Disease Quality of Life part 3	86
Figure 32. Kidney Disease Quality of Life part 4	87
Figure 33. Kidney Disease Quality of Life part 5	88
Figure 34. Kidney Disease Quality of Life part 6	89
Figure 35. Kidney Disease Quality of Life part 7	90
Figure 36. Kidney Disease Quality of Life part 8	91
APPENDIX 92
Appendix 1. Certification of human study approval part 1 92
Appendix 2. Certification of human study approval part 2 93
                                    

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