研究背景：
研究證實老人柔軟度較年輕人差，因而影響老人平衡能力及執行日常生活活動。臨床研究雖曾運用「維持或增加柔軟度的運動」於健康老人身上，卻少有對功能退化快速的失智老人，作運動對其柔軟度成效的探討。
研究目的：
本研究探討肌力及伸展運動，對於失智老人及一般老人身體柔軟度的成效，另檢視與柔軟度相關的平衡能力及日常生活功能是否也隨之改變。另本研究亦探討失智老人肌力及伸展運動後之各項指標成效與一般老人未參與運動的各項指標之距離是否拉近。
研究方法：
本研究採用前後測設計，招募社區中大於65歲的失智及一般老人，依其有無失智症的就醫診斷及個人運動參與意願分組，共招募受試者60人，完成前後測者共27人，分別為實驗組一（失智介入組，n=8）、控制組一（失智控制組，n=8）、實驗組二（一般介入組，n=6）及控制組二（一般控制組，n=5）。在人口學資料及臨床特徵上，失智介入組與失智控制組在性別、伴隨疾病數的分類、過去三個月有無跌倒紀錄、臨床失智評分量表分數的分類、年齡、接受教育年數、身體質量指數、簡短式智能評估分數並無差異；一般介入組與一般控制組除在接受教育年數上存在顯著差異，其餘皆無差異；失智介入組及一般控制組的人口學資料及臨床特徵在年齡、接受教育年數及簡短式智能評估分數上存在顯著差異。
研究期間控制組維持原有生活作息；實驗組每週接受肌力及伸展運動介入3次，每次運動時間50分鐘，為期12週。並分別於介入前及介入12週後，以雙手後背伸展測量（back scratch test）評量上半身柔軟度，以坐椅姿體前彎測量（chair-sit-and-reach test）評量下半身柔軟度、以伯格氏平衡量表(Berg Balance Scale)評量平衡能力及以功能獨立測量（functional independent measurement）評量日常生活功能，以此檢視肌力及伸展運動的介入，對於失智老人及一般老人身體柔軟度的成效，進一步檢視和與柔軟度相關的身體功能，如：平衡能力及日常生活功能的改變。
研究結果：
肌力及伸展運動介入的確有助於老人上半身柔軟度的改善：12週後，一般介入組上半身柔軟度提升，失智介入組在非慣用側上半身柔軟度提升；一般控制組在上半身的柔軟度前、後測並無顯著差異，失智控制組在上半身柔軟度則明顯退化。另肌力及伸展運動介入有助於延緩一般老人上半身柔軟度的退化。且肌力及伸展運動介入有助於拉近失智老人與一般老人在非慣用側上半身柔軟度的距離（P值由原先0.019的顯著差異，提升至0.284的無顯著差異）。
各組下半身柔軟度的前後測雖未見顯著差異，但可以發現兩組控制組下半身柔軟度前後測變化以呈現下降傾向者居多，失智介入組下半身柔軟度前後測變化則以呈現持平傾向者居多，一般介入組其前後測變化以呈現上升傾向者居多。
各組在與柔軟度相關的平衡能力及日常生活功能表現前後測雖無顯著差異，但可觀察到在平衡能力方面，控制組與介入組相較，後測分數退步皆較多。
研究結論：
初步得到的結論是：（1）執行肌力及伸展運動的失智及一般老人比起沒參與此運動的老人可改善其上半身柔軟度功能以避免退化。（2）失智老人沒參與肌力及伸展運動者其上半身柔軟度功能退化明顯。（3）肌力及伸展運動有助於拉近失智老人與一般老人在非慣用側上半身柔軟度的差距。
整體而言肌力及伸展運動不需特別設備，簡單易於執行，可維持老年人上半身柔軟度功能，是值得進一步研究提升失智老人身體功能的非藥物替代療法。
流失率高、完成後測比率偏低造成分析樣本數量不如預期及下半身柔軟度介入強度不夠，都可能是本研究不盡完善和未來須將強的部份。
未來研究可進一步探討肌力及伸展運動在不同失智診斷老人身上的成效，以及家屬介入協助失智老人執行肌力及伸展運動之效果。

Background:
Studies have confirmed that the older adults had significantly less flexibility than the younger adult, and that the decreased flexibility can affect the old adults’ balance ability and consequently hinder their performance in daily living activities. Clinical researches have intervened training programs to maintain or to increase flexibility for the healthy elderly, but few programs have focused on the demented elderly, for whom function degenerated faster than the healthy ones.
Objective:
This study was conduct to investigate the effectiveness of a strength and stretch training program on flexibility, and balance ability and the performance of activities of daily living related to flexibility in the demented elderly. In addition to compare scores change before and after intervention program the study also examined the gap between scores of the demented elderly after intervention and those of the healthy elderly without intervention.
Methods：
This was a pre-post test study design. The elderly aged older than 65 years with or without dementia diagnosis were recruited from the community. Each participant was assigned to the intervention group or control group based on their volition.
Twenty-seven of 60 eligible subjects with 8 in demented intervention group, 8 in demented control group, 6 in healthy intervention group, and 5 in healthy control group completed pre and post tests on The Back Scratch Test, The Chair-Sit-and-Reach Test, and The Berg Balance Scale, The Functional Independent Measurement for determining upper body flexibility, lower body flexibility, balance ability and the performance in activities of daily living. There were no significant differences between the demented intervention group and the demented control group on gender, number of comorbidity disease, and number of fall records during past three months, classification of Clinical Dementia Rating scale, age, years of education, body mass index, and the Mini-mental state examination scores. There were no significant differences between the healthy intervention group and the healthy control group, in demographic characteristics except for the years of education. However, there were significant differences between the demented intervention group and the healthy control group in the age, years of education, and the Mini-mental state examination scores
The control groups maintained their original lifestyle during the study period, while the experimental groups attended the strength and stretch training programs that included warm-up, muscle-strengthening activity, and slow-sustained stretching to improve flexibility. The participants of the experimental groups took the training three times per week (each time 50 minutes) for 12 weeks.
Results：
For flexibility of upper body, both the demented and healthy intervention groups had significantly increased their flexibility; the demented intervention group had significantly increased the non-dominant side upper body flexibility; while the health intervention group had increased the upper body flexibility and dominant side upper body flexibility. The demented control group had significantly decreased their upper body flexibility and dominant side upper body flexibility. There were no significant differences between pretest and posttest on the upper body related flexibility in the healthy control group. The intervention program was helpful to increase or to slowly deteriorate on upper body flexibility and non-dominant side upper body flexibility in the healthy elders. The intervention program was also helpful to narrow the gap of the non-dominant side upper body flexibility between the demented intervention group and the healthy control group (P value changed from significant [0.019] to non-significant [0.284] ).
For the flexibility of lower body, there were no significant differences between pretest and posttest on lower body flexibility for 4 groups. Both control groups tended to decrease lower body flexibility but the decrease was not statistically significant. The demented intervention group tended to be no changed and the healthy intervention group tended to increase.
For balance ability, there were no significant differences between pretest and posttest for all 4 groups. The healthy intervention group tended to be no changed on while the other groups tended to decline.
For performance in activities of daily living, there were no significant differences between pretest and posttest for all 4 groups. The demented intervention group tended to increase while the other groups tended to be no changed.
Conclusions：
The conclusions from this preliminary study were: (1) The elderly who attended the strength and stretch training program were more likely to enhance upper body flexibility; (2) The demented elderly without strength and stretch training were observed significant decrease on upper body related flexibility; (3) The demented elderly who attended the strength and stretch training program were more likely to narrow the gap of non-dominant-sided upper body flexibility as compared to the healthy control group.
The strength and stretching training program was simple and easy to conduct. Findings of this study suggested that application of the program could improve upper body flexibility for elderly in the community.
The high turnover rate, low post-test completion rate, and the exercise intensity of intervention program on lower body flexibility were the limitation of this study, and could be improved in future study.
Future researches could be directed to investigate the effectiveness of strength and stretch training program on flexibility, balance ability and the performance of daily living in elderly with different diagnosis of dementia. and to investigate the effectiveness of family participation in a strength and stretch training program to assist the elderly with dementia.

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