背景：台灣地區已於民國82年進入「高齡化社會」，並於民國107年正式進入了「高齡社會」，而隨著年齡增長，高齡者維持身體與活動的能力也逐漸衰退，導致生活品質低落，因而容易發生意外，尤其以因下肢功能性降低所致的跌倒最為常見。多數的研究透過規律運動能增進高齡者的下肢功能、改善敏捷能力與身體控制等身體因素，且能有效提升敏捷能力、降低可能跌倒的風險，但在不同場域進行之運動課程會產生不同的影響或刺激，又何種類型之運動課程對於高齡者的敏捷能力，有其實質正面且更大之效益，仍有待進一步探討。
目的：比較在健身房與社區不同場域之12週整合式運動課程，對於社區高齡者各項敏捷能力與功能性體能指標之影響。
方法：本研究以居住於都市社區之80位高齡者(年齡: 72.3±8.05歲)為實驗受試者，分為社區健康衛教健腦組(衛教組27人)、社區整合式運動組(社區運動組27人)與健身房整合式運動組(健身房組26人)共三組，透過為期12週、每週2次、每次90分鐘有專人指導之介入課程，分析並探討課程介入前、後，受試者對於各項敏捷能力指標之改變程度，測驗項目包括功能性體適能檢測(下肢肌耐力、平衡能力)、反應時間測驗(簡單反應時間、簡單動作時間、整體反應時間)與本體感覺能力。前測數據以單因子變異數分析(One-way ANOVA)比較三組介入前各變項之差異，並以前測、年齡與性別為共變量進行單因子共變數分析(One-way ANCOVA)分析三組於12週課程介入後依變項之改變情形。
結果：共55位高齡者完成12週之介入課程與前、後測。在下肢肌耐力的改變:三組之間並無顯著差異(健身房組: -0.26%；社區運動組: +13.99%；衛教組: +3.59%)；靜態平衡能力部分，雖然各組均有改善，但三組間亦無達到顯著差異(健身房組: +3.49%；社區運動組: +52.48%；衛教組: +110.54%)；動態平衡能力部分，健身房組(12.11%)與社區運動組(7.89)兩種不同場域之整合式運動訓練組相較於衛教組(1.03%)，皆能顯著提升高齡者之動態平衡能力(p <.05)，且健身房組顯著優於社區運動組 (p <.05)。在反應時間項目中，簡單反應時間平均值，健身房組(13.79%)相較於社區運動組(4.17%)和健康衛教組(0.28%)皆顯著進步( p <.05)，且健康衛教組顯著進步於社區運動組 ( p <.05)；簡單反應時間最佳值，健身房組(13.01%)與衛教組(3.88%)皆顯著進步於社區運動組(0.97%)( p <.05)；簡單動作時間平均值，兩組運動組與衛教組相較，皆無達到顯著差異(健身房組: -13.96%；社區運動組: +0.09%；衛教組: -8.01%)；簡單動作時間最佳值，健身房組(19.39%)顯著進步於社區運動組(5.06%)( p <.05)；整體反應時間平均值，健身房組(14.75%)顯著進步於社區運動組(1.56%)( p <.05)；整體反應時間最佳值，健身房組(17.25%)皆顯著進步於衛教組(5.19%)與社區運動組(2.24%)，衛教組(5.19%)又顯著進步於社區運動組(2.24%)( p <.05)。在本體感覺項目中，開眼硬地部分，三組之間並無達到顯著差異(健身房組: -5.30%；社區運動組: +3.46%；衛教組: -6.75%)；閉眼硬地部分，健身房組(0.83%)與衛教組(10.40%)之平衡表現皆顯著進步於社區運動組(20.66%)( p <.05)；開眼軟墊部分，三組之間並無達到顯著差異(健身房組: +6.29%；社區運動組: +10.22%；衛教組: -4.04%)；閉眼軟墊部分，三組之間並無達到顯著差異(健身房組: -1.14%；社區運動組: -1.83%；衛教組: -12.91%)。
結論：不同的運動場域經由12週短時間之課程介入後發現，全身性的整合式運動均可強化高齡者敏捷相關能力。其中以多器材為主的健身房教學可同時強化高齡者的上、下肢整體能力；以強調手眼協調認知活動之健康衛教組具有能改善以專注力為主的簡單反應時間(上肢)的專一性；以含有步態訓練的健走運動設計之身體活動訓練為主的健身房、社區運動，皆能達到強化全身性的動態平衡及敏捷效果。建議未來如有可能則以健身房之整合式運動訓練為優先；亦可在社區依據多元化的整合式運動結合步態訓練，並加入認知活動(健腦)之訓練以強調專注力訓練，以增進高齡者反應能力表現與改善動態敏捷之能力，降低社區高齡者未來可能發生跌倒等意外之風險。

Background: Herein, agility refers to the ability of older adults to move freely and swiftly for the purpose of maintaining the activities of daily living (ADLs) and completing tasks. Agility involves the integration of vision, attention, reaction time, lower extremity muscle strength, and balance, and has been closely linked to reduction in the number of falls.
Purpose: This study is aimed toward a comparison of the effectiveness of different site-based (gym and community) facilities for multi-component exercise program interventions in terms of improving reaction time and dynamic balance in community-dwelling older adults.
Methods: 80 community-dwelling older adults ranging in age from 72.3±8.05 years were assigned into three groups: a community-based group (COM, n= 27), a gym-based group (GYM, n=26), and a control group (CON, n = 27). The exercise groups engaged in the 90 minutes low-and medium-intensity multi-component exercise group program 2 days per week for 12 weeks that involved a combination of stretching, strength, balance, agility, and aerobic exercise. Hand-eye coordination activities (no exercise), and community-based health literacy interventions were conducted for the control group. The primary outcome measures included senior functional fitness test (lower limb muscle strength, balance), reaction time test (simple reaction time, simple movement time, total reaction time, and the detection of proprioceptive ability of ankle before and after interventions. A one-way ANCOVA was used to analyze the changes in the indicators of agility.
Results: After the intervention period, of the 80 participants, 55 completed the 12-week programs. Changes in muscle strength of lower limbs, there were no significant differences between the three groups (GYM: -0.26%, COM: +13.99%, CON: +3.59%). The ability of static balance, there were also no significant differences between the three groups (GYM: +3.49%, COM: +52.48%, CON: +110.54%). In whole body agility and dynamic balance, GYM (-12.11%) and COM (-7.89%) were significantly faster than the CON group (-1.03%) (p <.05). In the reaction time, the average reaction time, the GYM (-13.79%) was significantly better than the COM group (+4.17%) and the CON (+0.28%) (p <.05), and the CON (+0.28%) was significantly better than the COM group (+4.17%) (p <.05). In the attention, the attention time of the GYM (-13.01%) and the CON (-3.88%) were significantly improved than the COM group (+0.97%) (p <.05). In the average simple movement time, there were no significant differences between the three groups (GYM: -13.96%, COM: +0.09%, CON: -8.01%). The best in simple movement time of the GYM (-19.39%) was significantly improved than the COM (+5.06%) (p <.05). The average total reaction time, the GYM (-14.75%) was significantly better than the COM group (+1.56%) ( p <.05). The best in ability of total reaction time of the GYM (-17.25%) was significantly better than the CON (-5.19%) (p <.05) and COM (+2.24%) (p <.05). In the proprioceptive project, the open-eye firm surface, there were no significant difference between the three groups (GYM: -5.30%, COM: +3.46%, CON: -6.75%). In the close-eye firm surface, the balance between the GYM (-0.83%) and the CON (-10.40%) was significantly better than the COM group (+20.66%) (p <.05). In the open-eye foam surface, there were no significant difference between the three groups (GYM: +6.29%, COM: +10.22%, CON: -4.04%).In the close-eye foam surface, there were also no significant differences between the three groups(GYM: -1.14%, COM: -1.83%, CON: -12.91%).
Conclusion: These findings indicate that participating in the gym-based, which focused specifically on learning more equipment that can improve the attention, action and reaction time. The hand-eye coordination of cognitive activities only can improve the attention time. Both gym-based and the community-based multi-component exercise can improve the ability of dynamic balance in community-dwelling older adults. Therefore, the findings suggest improving the ability of agility in community-dwelling older adults; gym-based multi-component exercise program is a priority. In addition to, community-based multi-component exercise program combining cognitive activities may have the same effectiveness as the gym-based.

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