背景與目的：
慢性阻塞性肺病(COPD)是一個常見的呼吸道疾病，於2020年時成為了全球第三大死因，除了本身造成的呼吸不順、呼吸困難的問題之外，幾乎每位肺阻塞患者都會遇到的問題是急性惡化慢性阻塞性肺病(AECOPD)，急性惡化會造成患者的體力、肌力、運動耐受度、生活品質都會受到嚴重的影響，更會因為發生過一次惡化之後，隨著體力的逐漸下滑，導致惡化變得更加嚴重，形成一個惡性循環，而要破除此惡性循環，最好的方法是使用肺復原介入。肺復原介入包含了用藥、衛教、心理支持、給予運動訓練進行，最主流的部分為進行用藥物進行控制。然而用藥仍有所不足，藥物可以控制患者的症狀，但是卻無法改善患者不願意活動的情形，維持坐式生活，無法使身體活動狀況獲得改善，導致仍有機會發生惡化或症狀出現的情形。因此肺復原中的運動訓練也需要被添加進去，主流的做法為有氧運動訓練，雖可以改正患者坐式生活的問題，但是對於肌力本身卻是沒有太大的進展，導致患者仍然有肌力不足及功能性狀態不佳的情形。另外，日常生活活動中常需要有上肢的介入，然而上肢的肌力不足卻容易引發呼吸困難及功能能力不足的情形，但常規的訓練當中，卻是皆以下肢為主，忽略了上肢的訓練。因此，需要給予患者其他的訓練方式改善用藥及有氧訓練的不足，以及針對上肢肌力進行修正。
肺復原雖可以改善患者的體能及日常生活，但其參與率及維持率卻十分低迷，主因為患者認為訓練效果不佳及缺乏動機，因此需要找尋方法來改善患者參與及維持率不佳的狀況。
方法：
本研究將患者區分成兩個組別，控制組為進行常規的肺復原衛教及用藥，額外給予簡易的肢體活動，並使用通訊軟體進行監督及給予建議。介入組除原有的肺復原內容外，再添加以上肢為主的重量訓練，並輔以虛擬實境的方式進行遊戲內容。兩組皆進行24次的聯絡或訓練課程，並進行4次的運動測試，了解參與者的肌力、肺功能、攝氧量及生活品質；前測於聯絡或訓練開始前進行，作為給予患者建議及訓練的數據依據；期中測驗於完成12次聯絡或訓練後進行，作為後續的改善建議依據；後測於完成24次聯絡或訓練後進行，了解全部聯絡或訓練所帶來的效果；追蹤測驗為完成聯絡及訓練後1個月進行，作為了解參與者未監督之情形，1個月的變化狀況。每次測驗再測驗過後皆會告知參與者測試結果與先前數據的比較，用以讓參與者了解肺復原所帶來之成效。
結果：
介入組在經過訓練過後，於4次測驗中皆有出現預期的結果，肌力、最大及休息時攝氧量差值、生活品質、對運動的附著度及再住院率皆有獲得統計上顯著差異的改善，而受監督的控制組也有六分鐘行走距離方面的改善效果。
結論：
透過給予上肢為主重量訓練，輔以虛擬實境之肺復原運動項目，得到了顯著差異的進步。代表給予重量訓練於上肢及搭配虛擬實境可以改善先前肺復原的問題，成為一個新的替代選項。

Background and Purpose:
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease becoming the third leading cause of death. It is not only breathlessness, but also poor exercise capacity; moreover, patients of COPD nearly occur acute exacerbation (AECOPD) once per year, which induces much worse exercise capacity, functional capacity, quality of life, pulmonary function, and higher hospital readmission rate. There is a vicious circle for AECOPD patients, due to their physical inactivity. To ameliorate the vicious circle, pulmonary rehabilitation is the solution to deal with AECOPD. Pulmonary rehabilitation includes pharmacological therapies, psychosocial support, nutritional intervention, education, exercise training. The main option of pulmonary rehabilitation is pharmacological therapies, it can help to control the uncomfortable symptoms, but it is hard to change physical inactivity and sedentary life; therefore, we can add exercise training into pulmonary rehabilitation, the major choice is aerobic exercise, it indeed changes exercise capacity, quality of life and alteration of sedentary life; however, muscle strength of patients is hard to improve by aerobic training, which is a chance to occur exacerbation and musculoskeletal weakness. Moreover, upper limbs are involved in activities of daily living the most, it is seldom trained in pulmonary rehabilitation, which is caused breathlessness and dyspnea easily. Therefore, we should give patients other training programs to ameliorate the lack of pharmacological therapies, aerobic exercise, and upper extremity training.
Although we know pulmonary rehabilitation can bring lots of benefits to AECOPD patients, the referral and adherence rate of exercise training in pulmonary rehabilitation is low, the reasons make this problem is that lack of motivation and benefits; therefore, we need to find a solution to deal with the low rate of referral and adherence.
Methods：
We divided participants into two groups, control group followed usual pulmonary rehabilitation education and pharmacological therapies, and taught them some limbs exercise, using social application to contact and suggestion giving as supervision. Intervention group had not only usual pulmonary rehabilitation, but also upper extremity weight training with virtual reality. Two groups had 24 sessions of contacts and training programs, and 4 times of assessments, which were used to analysis participants muscle strength, oxygen uptake, pulmonary function, and quality of life. Pre-test was test before the beginning of contacts or training and considered as the basis of their suggestions and training protocols; mid-test was executed after 12 sessions of contacts or training, as the foundation of the last 12 sessions; post-test was implemented after finish of 24 sessions, as the investigations of 24 sessions; follow-up-test was 1 month after finishing 24 sessions, as results of the maintenance of without supervised exercise. Results of four times assessments was told to participants after finishing each measurement and compared with previous assessments, which was used to make participants realize their changes after pulmonary rehabilitation.
Results：
After training programs, intervention group showed the expected significant difference results in 4 times assessments, including muscle strength, delta value of maximal and resting oxygen uptake, quality of life, adherence rate of exercise and hospitalization readmission rate. Supervised control group had improved significantly in six minutes walking test.
Conclusion：
Exercise programs of upper extremity weight training with virtual reality had a significant improvement, which represented this training programs can revise the problems of pharmacological therapies and aerobic exercise, becoming another option of pulmonary rehabilitation.

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