背景：社區老年人的衰弱盛行率，若分別以身體的及多面向的衰弱定義來看，約為9.9% 及13.6%。衰弱被視為是由強健到功能衰退的轉變狀態，最常見的結果依序為死亡、失能及入住機構。臨床上醫師應區分出老年病人的健康問題是正常老化或衰弱，若為衰弱則應積極介入，以預防反覆跌倒、感染、住院、入住機構、或死亡等後續不良事件發生。研究指出以運動介入社區衰弱老年人，可減少其身體依賴、增進身體功能、提升生活品質及認知。本研究的目的為以登階運動介入社區衰弱中老年人，以探知其對身體功能改善的成效。
方法：本研究為非盲隨機對照試驗，於南部某區域醫院張貼招募海報，收案對象為可自行行走及上下階梯(可使用輔具)且符合衰弱條件之一 (3公尺行走折返＞10秒；30秒起立坐下次數＜5次；自覺費力2或3分；或最近一年內曾跌倒≧2次)之社區≧55歲中老年人。實驗組之介入為每次20~30分鐘，每週3次，共4週12次的登階運動訓練；對照組則給予運動衛教單張。於收案後、2週後以及4週後測量9項身體功能，包含平常行走速度、6分鐘行走距離、30秒起立坐下次數、30秒曲臂次數、計時起立行走3公尺、身體質量指數、自覺費力分數、自評跌倒關注程度量表以及歐洲五維生活品質量表。統計則使用重複量數單因子變異數分析比較兩組的9個依變項在三個時間點的差異，也用重複量數二因子變異數分析比較兩組在9個依變項的變化趨勢的差異
結果：本研究共收案27人，有效樣本數為24人，其中實驗組12人(女性6位，男性6位，平均75.6歲)，對照組12人(女性6位，男性6位，平均79.0歲)，兩組於研究介入前在社會人口學、身體測量、疾病變項及9個依變項均無顯著差異；以重複量數二因子變異數分析，顯示4週之登階運動訓練能有效改善平常行走速度、6分鐘行走距離、30秒起立坐下次數、計時起立行走3公尺、自評跌倒關注程度量表以及歐洲五維生活品質量表(p<.0001)，且這6個測量結果在三個評估時間點之間亦呈顯著差異；但30秒曲臂次數、身體質量指數及自覺費力分數等三項於兩組之間則無顯著差異。
結論：4週且每週3次共12次的登階運動訓練是一種能提升社區衰弱中老年人身體功能之運動介入方式。
關鍵字：衰弱;登階運動;老年人;隨機對照研究;身體功能

Background: The prevalence of frailty in community-dwelling elderly has been shown to be 9.9% and 13.6% with respect to the definitions of the physical and multi-domain phenotype. Frailty is considered to be a transitional state from robustness to functional deterioration. Death, disability and institutionalization are the most common outcome of frailty. The difference between normal aging and frailty should be carefully clarified in clinical settings, and active intervention is also suggested to prevent the unwholesome results such as repeated falls, infection, hospitalization, institutionalization and death. The intervention of exercise for the frail elderly may decrease the degree of physical dependence and may also enhance the functioning, quality of life and cognition of this group. The aim of this study is to investigate the effect of step exercise on physical frailty in community-dwelling frail middle-aged and elderly people.
Methods: A nonblinded randomized control study was conducted. We posted recruitment posters in a southern regional hospital. Aged 55 or older community-dwelling people who could walk and up and down stairs independently with or without using assistant devices who also met one of the frailty criteria (3-meter walk and back at a quick comfortable pace > 10 seconds, 30-second Chair Stand< 5 repetitions, self-reported exhaustion 2 or 3 scores, or who had fallen in the previous year ≧ 2 times) were recruited. The experimental group was scheduled to receive step exercise (12 times over a 4 week period for 20~30 minutes each time, 3 times per week). The control group received an exercise health education leaflet. The evaluation was conducted on the 0th, 2nd and 4th week (W0, W2 and W4). The measures include the Usual Gait Speed (UGS), the 6-Minute Walking test (6MW), the 30-second Chair Stand (30-s CS), the 30-second Arm Curl (30-s AC), the Timed Up-and-Go (TUG), Body Mass Index (BMI), self-reported exhaustion, the Falls Efficacy Scale International (FES-I) and the Euroqol Five Dimensions questionnaire (EQ-5D).
Results: Twenty seven participants were recruited. The effective sample size was 24, including 12 in the experimental group (6 female, 6 male, average 75.6 y/o) and 12 in the control group (6 female, 6 male, average 79.0 y/o). No significant difference was found in regard to sociodemographics, anthropometrics, medical conditions and the 9 outcome measures between the two groups before the intervention. By using a Repeated Measures two-way ANOVA analysis, we found that 4-week step exercise training could improve UGS, 6MW, 30-s CS, TUG, FES-I and EQ-5D (p<.0001), and there were significant differences between W0-W2, W2-W4, W0-W4. No significant differences were found in the 30-s AC, BMI and self-reported exhaustion between the two groups.
Conclusion: The 4-week, 3 times per week step exercise is an effective intervention to enhance physical performance in frail community-dwelling middle-aged and elderly people.
Keywords: frailty, step exercise, elderly, randomized control study, physical performance

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