研究背景：衰弱的症狀有預期體重減輕、低握力、自述精疲力竭、行走速度緩慢及低身體活動量，可能導致高齡者失能、跌倒、住院、住進安養機構、甚至增加死亡風險。因此，導致健康照護費用增加。臺灣長照機構高齡者衰弱盛行率達33.2%，衰弱前期更高達59.1%。衰弱不只影響生理功能，也可能造成認知功能衰退。研究指出認知功能降低會增加衰弱的風險。運動可以改善高齡者的衰弱狀態，亦可增進特定的認知功能。亦有研究發現以認知訓練介入，可增進步行速度和姿勢穩定，進而減少跌倒的發生。日常生活常需同時執行身體活動和認知的多重任務能力，而目前研究多使用單一運動或單純認知介入，較少探索運動同時合併認知介入對衰弱的效果。本研究目的探討結合認知訓練的運動介入對於機構衰弱高齡者的衰弱狀態、認知功能、憂鬱、生活品質之成效。
研究方法：本研究從台灣南部長照機構中徵求65歲以上衰弱及衰弱前期高齡者。採用類實驗設計，以機構為單位採取隨機分派至認知訓練合併運動組與單純運動組。兩組都接受24週，每週2次，每次60分鐘的運動介入。單純運動組接受整合性運動，內容包含肌力、有氧、柔軟度訓練。結合認知訓練的運動介入組接受同樣強度的整合性運動，並將認知的注意力、記憶、算術、語意流暢度之任務與運動動作結合。例如參與者在執行坐姿踏步運動時，必須同時運算數字加減。統計分析以描述性統計呈現人口學資料，使用T檢定與卡方檢定比較兩組在前測時，人口學變項、衰弱狀態、認知功能、生活品質、憂鬱是否有差異。以混合線性模型分析(linear mixed model)比較接受介入前(第0週)、中(第12週)、後測(第24週)，兩組在衰弱狀態、認知功能、生活品質、憂鬱的改變量，是否有顯著差異。
研究結果：兩組的認知功能在前、中測(t = 3.29, p = 0.001)以及前、後測(t = 4.61, p < 0.001)之間的改變量有顯著的交互作用，結合認知的運動介入組改善程度優於單純運動組。兩組的衰弱狀態在前、中測(t = 2.85, p = 0.005)之間有顯著的交互作用，單純
運動組則優於結合認知的運動介入組。兩組在生活品質、憂鬱則沒有顯著的差異。事後比較的結果顯示：結合認知訓練的運動介入組的認知功能從前測到中測(p < 0.001)及前測到後測(p < 0.001)有顯著的提升。而單純運動組的衰弱狀態從前測到中測(p < 0.001)及前測到後測(p < 0.001)有顯著的改善。
結論：結合認知訓練的運動介入可以改善機構衰弱高齡者的認知功能；但僅有單純運動介入有改善衰弱程度。

Frailty may lead to adverse health outcomes and increased health care costs in older adults. Decreased cognitive function increases the risk of frailty. Exercise can improve the frail state of older adults and enhance specific cognitive functions. However, few studies explored the effect of exercise combining cognitive training on frailty. The aims of this study were to investigate the effects of an exercise intervention combining cognitive training on frailty, cognitive function, depression, and quality of life (QOL) among frail older adults in long-term care facilities. Aged 65 and over frail older adults were recruited from nursing homes and long-term care institutions in Southern Taiwan. Quasi-experimental design was conducted and participants were randomly assigned to the exercise combining cognition (EC) or the exercise group (EX) based on the institutions where they stayed. All participants received 60-minute exercise training sessions, 2 times a week for 24 weeks. EX group received integrated exercise, and EC group received the integrated exercise with the same intensity and combining cognitive training. Mixed linear model was used to compare the changes in frailty, cognitive function, quality of life, and depression between the two groups at 0, 12, and 24 week. After 24-week exercise intervention, EC group demonstrated significant improvement in cognitive function. However, only EX group showed improvement in frailty. In the future, it is recommended that the exercise could be implemented to prevent or delay disability for frail elderly care in long-term care facilities and community.

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