背景與目的：跌倒是造成台灣老年人意外死亡的第二大主因，而被障礙物絆倒是跌倒常見的肇因之一。因此，有良好的步態調節能力來避免絆倒發生是很重要的。行走過程中，當一個不預期的擾動(像是障礙物)出現時，人們會調節自己的步態去防止跌倒的發生。然而，老化會使步態調節能力下降，使年長者絆倒的風險增加。針對跌倒的預防，過去的學者使用阻力運動或水中有氧訓練跨障礙物時的步態調節能力。然而，這類型的運動需要高度的監督，除了加重醫療支出，也會因運動內容單調而降低年長者參與的意願。因此，此篇研究使用功能性舞蹈運動作為運動介入。有別於一般的舞蹈運動，此舞蹈動作會針對年長者不足的能力去做設計，像是肌力、平衡、重心轉移及協調能力，並且搭配著流行音樂增加此運動的趣味性。然而，到目前為止尚未有研究探討不同位置的障礙物，對於老年人在跨障礙物時的步態調節能力之影響。因此，本篇研究目的共有兩項：（1）探討功能性舞蹈運動對於社區老年人在跨障礙物時的步態調節能力之效益。（2）探討不同位置的障礙物對於老年人步態調節能力之影響。

方法：本實驗收納了29位60歲以上的健康老年人，其中14位為跳舞組，15位為控制組。受試者在介入前後皆須接受跨障礙物之任務、臨床評估測試及填寫憂鬱量表。跨障礙物之任務為：實驗者會隨機投影虛擬障礙物至跑帶上，當受試者看到障礙物的出現，須立即調節步態並跨越此障礙物，過程中會使用動作分析系統及錄影機收集跨步動作之時間空間參數、關節角度及成功次數。跳舞組會接受8週的功能性舞蹈運動介入，控制組則會給予衛教本及運動指導。本實驗使用三因子變異數重複測量分析(重複因子為時間及位置)比較兩組任務表現的測量結果。二因子(組別與時間)變異數重複測量用於臨床評估測試及憂鬱量表。

結果：經過8週的訓練，在跨障礙物之任務中，跳舞組增加了跨越步長、腳尖離地高度、跨越速度和最大膝屈曲角度，並且降低擺動時間和反應時間。在成功跨越率中，跳舞組在介入後有些微增加的趨勢，但並未達到統計意義，而這個趨勢並未表現在控制組上。另外，在位置3的跨障礙物表現中，受試者須增加跨越步長、步寬、腳尖離地高度、跨越速度、髖關節彎曲角度及踝關節背屈角度，因此，位置3之跨越成功率為三個位置中最低的。

結論：在經過8週的運動訓練後，跳舞組在跨障礙物時的步態調節能力表現有明顯進步。此外，因為反應能力的進步，使得跳舞組在反應時間測試當中，所需時間減少。步長、腳尖離地高度、跨越速度和最大膝屈曲角度的增加，都可能會降低年長者跌倒發生的風險。在成功跨越率中，跳舞組也呈現正向趨勢，但未達統計上明顯差異。功能性舞蹈運動對於社區老年人在跨障礙物時的步態調節能力是有效益的，而它並不需要昂貴的成本且極富趣味性。對於高齡化社會的台灣，也許是一種合適的防跌訓練。此外，障礙物的位置也會影響老年人步態調節能力的表現。當障礙物距離增加時，老年人需做較多的步態調節及較長的反應時間去跨越障礙物，因此成功率是降低的。表示障礙物離得越遠，對老年人來說越具挑戰性。

Background and purposes: Falling is the second common cause of the older accidental death in Taiwan, and tripping over an obstacle is one of the common fall conditions. Therefore, the ability of an effective step adjustment to avoid obstacles is important. During walking, people will adjust their step to avoid falls when an unexpected disturbance appears (such as an obstacle). However, the ability of step adjustment deteriorates with aging and the reduction of this ability may increase risk of falls in the elderly. To improve the ability of obstacle negotiation, previous researchers used resistance training or aquatic endurance exercise, which are effective for falls prevention. However, this kind of intervention not only increases medical expenditure for large numbers of supervision, but also decreases the desire of older adults’ participation due to boring contents of the exercise. Hence, the functional exercise with dance training was used in the current study. Different from general dancing, the movements of this exercise are designed for the lack of ability in the elderly, such as muscle strength, balance, weight-shifting and coordination ability. This exercise executes with popular music in order to increase people’s interest. In addition, none of the previous studies has investigated the effects of different obstacle positions on the step adjustment ability. There are two purposes of this study: (1) to investigate the effects of functional exercise with dancing on the ability of step adjustment to avoid obstacles in community-dwelling older adults; (2) to investigate the effects of different obstacle positions on the step adjustment ability in the elderly.

Methods: Twenty-nine older adults aged above sixty years old participated in the experiment. The dance group was comprised of 14 subjects and the control group was comprised of 15 subjects. The participants would take the obstacle crossing task, clinical examination and fill in the depression questionnaire before and after intervention. The obstacle crossing task was as follows: the experimenter would randomly project virtual obstacle on the treadmill belt. The subjects had to adjust their step to cross over the obstacle immediately when they saw it. The temporal-spatial parameters, kinematic data and successful rate were recorded by the motion camera system and video recorder during crossing tasks. The dance group received an 8-week functional exercise with dance training and the control group received a booklet about falling prevention knowledge. Three-way ANOVA with repeated measures on time and position factors was used to analyze the performance of crossing over obstacles between two groups. Two-way ANOVA with repeated measure was used to analyze all clinical examination and depression scales.

Results: After 8 weeks training, the dance group increased their step length, toe clearance, crossing velocity and peak knee flexion, and decreased swing time and reaction time. The successful rate in the dance group slightly increased after intervention, but it did not reach the significant level. However, this trend was not found in the control group. In addition, the subjects had to increase the step length, step width, toe clearance, crossing speed, peak hip flexion and peak ankle dorsiflexion in the position_3 crossing. Moreover, the lowest successful rate was shown in the position_3 crossing.

Conclusion: The performance of step adjustment during obstacle crossing task improved significantly in the dance group after 8-week intervention. Besides, their reaction time also decreased after training. The increases of step length, toe clearance, crossing velocity and peak knee flexion might reduce the risk of falls in older adults. For the successful rate, the positive trend was found in the dance group. Functional exercise with dance training had positive effect on the ability of step adjustment to avoid obstacles in community-dwelling older adults and it was low cost and interesting. Therefore, it might be an appropriate exercise program for fall prevention for the aging society in Taiwan. Besides, obstacle position would interfere the step adjustment ability in older adults. The elderly had to adjust a longer and wider step, a more flexed limb and a higher toe clearance to cope with the farthest obstacle. Besides, the number of successful crossing step decreased as the distance of obstacle increased. It suggested that a farther distance of the obstacle was more challenging for the elderly.

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