背景：隨著醫療進步，平均餘命延長，人口逐漸老化，老年人口增多，罹慢性病和失能的老人人口隨之上升。過去研究發現身體活動是預防失能的方法之一，然而極少研究探討身體活動在老人身體功能隨時間變化(惡化)後對預防失能的效果。同時，過去有關身體活動對老人健康的影響之研究多數是探討對疾病的預防，較少探討功能退化的預防。

目的：本研究目的分兩大部分：一是在考慮老人身體功能隨時間變化後，探討臺灣地區老人身體活動的執行對後續功能退化的影響；第二部分則是進一步將身體活動的變化分為四種類型，分析不同類型的長期身體活動對老人晚年功能退化的影響。
方法：以臺灣地區中老年身心社會生活狀況長期追蹤調查系列(TLSA)1996年、1999年、2003年、2007年四波調查結果為材料，使用重複測量統計階層線性回歸模式方程式（Hierarchical Liner Modeling, HLM）分析。第一部份，依1996年、1999年、2003年身體活動問卷調查結果，將身體活動狀態分為：達運動建議量組、有運動未達建議量組、不動組，預測1999年、2003年、2007年的日常生活功能(ADL)、工具型日常生活功能(IADL)、基本活動能力(Strength and Mobility Activities)三個領域之功能退化情形。第二部份，依1996年、1999年、2003年共七年身體活動執行是否達運動建議量分為：持續運動組、後來開始運動組、後來停止運動組、持續不運動組，分析1999年、2003年、2007年的日常生活功能、工具行日常生活功能、基本活動能力三個領域之功能退化軌跡。

結果：第一部份，身體活動狀態可顯著預測老人往後功能的退化；相較於不動組，達運動建議量組顯著地預測較低的身體功能失能度，且隨時間自然老化，達運動建議量的身體活動仍然有顯著的保護作用，而有運動未達建議量組也能顯著預測較低的失能度，且隨時間自然老化，有運動未達運動建議量的身體活動亦有顯著的保護作用，但效果小於達運動建議量組。第二部份，相較於不運動組，11年追蹤期間仍持續運動組和後來開始運動組顯著預測較低的失能分數，且隨時間自然老化，仍然有顯著的保護作用，而後來停止組則不顯著。

討論：以臺灣地區的老年人代表性樣本做分析，任何身體活動量都達到延緩退化的效果，而若能達到建議量以上的身體活動量對功能退化的效果更佳。持續運動和後來才開始運動都能預測了較好的身體功能，後來停止運動雖不顯著，但仍有潛在延緩退化的效果。

Background: Life expectancy is getting longer as medical technology has been improving in decades. Rapid growth of aged population leads to the increase of elderly with chronic diseases or malfunction. Previous research has indicated that physical activity is significantly associated with physical function of elderly. However, there is still lack of evidence whether physical activity predicts better functional status as aging occurs. In addiction, most research has studied the association between physical activity and chronic diseases; little research has focused on the association between physical activity and functional status of elderly.

Objectives: There are two purposes in this study. First, when considering the natural process of aging, does physical activity still predicts better functional status over time? Secondly, we further divided the changes of physical activity into 4 types and analyzed whether different patterns of physical activity would lead to different effects of functional decline under the consideration of aging.

Method: We used the database of 1996、1999、2003、2007 surveys from Taiwan Longitudinal Study in Aging(TLSA) to understand whether physical activity are associated with the functional decline in three aspects, ADL, IADL, and mobility. Data was analyzed by Hierarchical Liner Modeling(HLM). Physical activity was stratified into three levels, the recommended level, the active level (not reach the recommended amount), and the sedentary. Also, patterns of physical activity in the study period were analyzed whether the trajectories of functional declining differ. These were four types of patterns: Always reach recommended level, Later reach recommended level, Later stop recommended level, and Always maintain inactive level.

Results: For the first objective, the status of physical activity status significantly predicts functional status. Compared to the sedentary, both the recommended level and the active level predict better functional status. Moreover, the above two levels significantly mitigate functional declining against aging. In the second part of analysis, compared to those who always maintain inactive level, those with always reaching recommended level and later beginning recommended level showed better trajectories of functional declining over time.The trajectory of those with later stop recommended level was not better than that in the group of always maintaining inactive.

Discussion: Based on the survey of representative sample of Taiwanese elderly, we conclude that any amount of physical activity can mitigate functional decline. Nevertheless, the recommended amount of physical activity can provide more protection of functional maintains. Continually living in recommended active lifestyle or starting living in recommended active lifestyle can help the elderly with maintaining functional status. For those who stopped living in recommended active lifestyle, it still had potential effects to maintain functional ability.

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