系統識別號 U0026-1807201615525200
論文名稱(中文) 活動促進系統對代謝異常者身體活動促進之成效
論文名稱(英文) The Effectiveness of an Activity Promotion System on Increasing Physical Activity in Subjects with Metabolic Abnormalities
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 104
學期 2
出版年 105
研究生(中文) 楊雅萍
研究生(英文) Ya-Ping Yang
學號 ta8021041
學位類別 博士
語文別 英文
論文頁數 65頁
口試委員 指導教授-王靜枝
中文關鍵字 身體活動  活動促進  自我管理  代謝異常  體重過重 
英文關鍵字 physical activity  activity promotion  self-management  metabolic abnormalities  overweight 
中文摘要 目的:本研究的目的為探討活動促進系統對於代謝異常者增加身體活動之成效。方法: 本研究為隨機試驗交叉研究設計,為期6個月。共招募53位受試者,以隨機分派方式分成A組及B組,A組受試者於前3個月使用活動促進系統(Activity Promotion System)包括穿載式感測器(可測量全日身體活動,包括睡眠時間、靜態、輕度、中度和劇烈身體活動)和線上的即時回饋系統,於後3個月為接受傳統健康教育的常規照護。B組的受試者則先接受常規照護後再使用活動促進系統。測量兩組介入前1週、不同介入措施介入後3個月及6個月的各項身體活動及代謝異常指標的變化。以獨立t檢定分析測試活動促進系統使用期間的效果;廣義估計方程式用於分析研究期間AB兩組之間的差異。差異中的差異分析用於組內和組間使用活動促進系統使用與常規照護的差異比較。結果:本研究發現受試者使用活動促進系統後,顯著減少靜態活動時間、增加輕度活動、每日活動總量和每日活動步數。對於代謝異常等生理指標,受試者腰圍於使用活動促進系統顯著減少。結論:活動促進系統對於代謝異常者而非糖尿病或心血管等疾病狀態者具有減少靜態活動時間並增加身體活動之效果。未來需有增加樣本數及長期的隨機對照研究,來進一步佐證活動促進系統臨床運用的有效性。
英文摘要 Objective: The aim of this study is to examine the effectiveness of Activity Promotion System (APS) on promoting physical activity (PA) for subjects with metabolic abnormalities.
Methods: We designed a 6-month randomized controlled trial with a cross-over design, and finally recruited 53 subjects. Subjects in group A used APS with a wearable device (which could measure whole-day physical activities including sleep time, sedentary, light, moderate and vigorous PA) and web-based feedback system in the first 3 months and followed by usual care with traditional health education in the next 3 months. Subjects in the group B took turn to receive the above programs in a reverse order. Physical activities and metabolic abnormalities were measured prior to the intervention, 3 months after the first intervention, and 6 months after the other intervention respectively. Independent t test was used to test the effects APS using. Generalized Estimating Equation (GEE) was used to analyze differences between two groups across research period. Difference in differences (DID) analysis were used to compare the difference within and between groups.
Results: This study found that the APS had short-term effects on decreasing sedentary time and increasing mild PA, moderate PA, total PA, and daily steps counts. The secondary outcome measures of metabolic abnormalities, APS provide a positive effect on decreasing waist circumference.
Conclusion: This APS appeared to decrease sedentary time and to increase PA for people with only metabolic abnormalities but not with metabolic syndrome, diabetes or cardiovascular disease. However, long-term studies with APS and larger sample size are needed to further confirm the effectiveness of this innovative activity promotion system.
論文目次 Abstract I
中文摘要 III
Acknowledgement V
Table of Contents VII
List of Tables IX
List of Figures X
Chapter 1 Introduction 1
1.1 Background 1
1.2 Research purpose 4
1.3 Operational definition 4
Chapter 2 Literature review 9
2.1 Prevalence of MetS and metabolic abnormalities 9
2.2 Negative impact of metabolic abnormalities and MetS 10
2.3 Lifestyle and metabolic abnormalities 12
2.4 PA and MetS 13
2.4.1 The impact of physical activities 13
2.4.2 The impact of sedentary behavior and physical inactivity 15
2.5 Strategies for PA promotion intervention 17
2.6 Mobile devices using for PA promotion 18
2.7 Summary 19
Chapter 3 Methods 21
3.1 Study design 21
3.1.1 Study setting 21
3.1.2 Study subjects 21
3.1.3 Instrument 22
3.2 Procedure of the study 25
3.2.1 Procedure of RCT 25
3.2.2 The Activity promotion system (APS) 28
3.2.3 Usual care (UC) 33
3.3 Data analysis 33
3.4 Ethical approval 34
Chapter 4 Results 35
4.1 Demographic characteristics of subjects 35
4.2 Effects of period with and without APS on outcome measurements 37
4.3 Effects of APS vs. UC between-group and within-group on outcome measurements 40
4.3.1 Effects of APS vs. UC within-group on outcome measurements in group A 40
4.3.2 Effects of UC vs. APS within-group on outcome measurements in group B 42
4.3.3 Effects of APS vs. UC between-group on outcome measurements from T1 to T2 43
4.3.4 Effects of UC vs. APS between-group on outcome measurements from T2 toT3 44
Chapter 5 Discussion 48
5.1 Positive outcomes 48
5.2 Outcomes which were not significantly improved 51
5.3 Limitations and future research 52
5.4 Conclusion 53
5.5 Implications for Practice 53
Reference 55
Appendix 1 63
Appendix 2 64
參考文獻 Alkahtani, S., Elkilany, A., & Alhariri, M. (2015). Association between sedentary and physical activity patterns and risk factors of metabolic syndrome in Saudi men: A cross-sectional study. BMC Public Health, 15, 1234.
Aoi, W., Naito, Y., & Yoshikawa, T. (2011). Dietary exercise as a novel strategy for the prevention and treatment of metabolic syndrome: effects on skeletal muscle function. Journal of Nutrition and Metabolism, 2011, 676208.
Appuhamy, J. A., Kebreab, E., Simon, M., Yada, R., Milligan, L. P., & France, J. (2014). Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials. Diabetology & Metabolic Syndrome, 6, 127.
Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., … Burke, L. E. (2010). Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation, 122(4), 406-441.
Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, P., Chen, K. Y., … Koster, A. (2011). Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes Care, 34(2), 497-503.
Bertrais, S., Beyeme-Ondoua, J. P., Czernichow, S., Galan, P., Hercberg, S., Oppert, J. M. (2005). Sedentary behaviors, physical activity, and metabolic syndrome in middle-aged french subjects. Obesity Research, 13(5), 936-944.
Bort-Roig, J., Gilson, N. D., Puig-Ribera, A., Contreras, R. S., & Trost, S. G. (2014). Measuring and influencing physical activity with smartphone technology: a systematic review. Sports Medicine, 44(5), 671-686.
Bradley, H., Shaw, C. S., Bendtsen, C., Worthington, P. L., Wilson, O. J., Strauss, J. A., … Wagenmakers, A. J. (2015). Visualization and quantitation of GLUT4 translocation in human skeletal muscle following glucose ingestion and exercise. Physiological Reports, 3(5), e12375.
Castro, M., Abrams, K., Davies, M. J., Willis, A., & Khunti, K. (2012). Metabolic syndrome and risk of cardiovascular disease, diabetes and mortality. Diabetic Medicine, 29, 39.
Chastin, S. F., Egerton, T., Leask, C., & Stamatakis, E. (2015). Meta-analysis of the relationship between breaks in sedentary behavior and cardiometabolic health. Obesity, 23(9), 1800-1810.
Chen, L. J., Lai, Y. J., Sun, W. J., Fox, K. R., Chu, D., & Ku, P. W. (2015). Associations of exercise, sedentary time and insomnia with metabolic syndrome in Taiwanese older adults: A 1-year follow-up study. Endocrine Research, 40(4), 220-226.
Chiou, M. J., Li, T. W., Lu, T. C., Tu, H. T., Tsai, Y. H., & See, L. C. (2013). The effectiveness of case management for metabolic syndrome: Pre- and post-test intervention trial with a control group. [The Effectiveness of Case Management for Metabolic Syndrome: Pre-and Post-test Intervention Trial with a Control Group]. Healthcare Quality, 5(1), 34-49.
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York: Routledge Academic.
Coons, M. J., Roehrig, M., & Spring, B. (2011). The potential of virtual reality technologies to improve adherence to weight loss behaviors. Journal of Diabetes Science and Technology, 5(2), 340-344.
Dunkley, A. J., Charles, K., Gray, L. J., Camosso-Stefinovic, J., Davies, M. J., & Khunti, K. (2012). Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabetes, Obesity and Metabolism, 14(7), 616-625.
Edwardson, C. L., Gorely, T., Davies, M. J., Gray, L. J., Khunti, K., Wilmot, E. G., . . . Biddle, S. J. (2012). Association of sedentary behaviour with metabolic syndrome: a meta-analysis. PloS One, 7(4), e34916.
Ekblom, Ö., Ekblom-Bak, E., Rosengren, A., Hallsten, M., Bergström, G., & Börjesson, M. (2015). Cardiorespiratory fitness, sedentary behaviour and physical activity are independently associated with the metabolic syndrome, results from the SCAPIS pilot study. PloS One, 10(6), e0131586.
Fanning, J., Mullen, S. P., & McAuley, E. (2012). Increasing physical activity with mobile devices: a meta-analysis. Journal of Medical Internet Research, 14(6), e161.
Ford, E. S. (2005). Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome a summary of the evidence. Diabetes Care, 28(7), 1769-1778.
Ford, E. S., & Caspersen, C. J. (2012). Sedentary behaviour and cardiovascular disease: a review of prospective studies. International Journal of Epidemiology, 41(5), 1338-1353.
Fu, T., Wen, T., Yeh, P., & Chang, H. (2008). Costs of metabolic syndrome-related diseases induced by obesity in Taiwan. Obesity Reviews, 9 Suppl 1, 68-73.
Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., ... Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334-1359.
Grundy, S. M. (2012). Pre-Diabetes, Metabolic Syndrome, and Cardiovascular Risk. Journal of the American College of Cardiology, 59(7), 635-643.
Haskell, W. L., Lee, I.-M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., … Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081.
Health Promotion Administration, Ministry of Health and Welfare. (2007a). booklet on metabolic syndrome prevention. Retrieved 0214, 2016, from http://www.hpa.gov.tw/BHPNet/Web/Books/manual_content15.aspx
Health Promotion Administration, Ministry of Health and Welfare. (2007b). The criteria of metabolic syndrome for adults more than 20 years old. Retrieved 0506, 2016, from http://www.bhp.doh.gov.tw/bhpnet/portal/Them_Show.aspx?Subject=200712250023&Class=2&No=200712250123
Health Promotion Administration, Ministry of Health and Welfare. (2014). The behavioral risk factor of surveillance system. Retrieved 0519, 2016, from https://olap.hpa.gov.tw/search/ListHealth1.aspx?menu=1&mode=16&year=103
Healy, G. N., Dunstan, D. W., Salmon, J., Cerin, E., Shaw, J. E., Zimmet, P. Z., & Owen, N. (2008). Breaks in sedentary time beneficial associations with metabolic risk. Diabetes Care, 31(4), 661-666.
Hu, F. B., Li, T. Y., Colditz, G. A., Willett, W. C., & Manson, J. E. (2003). Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA, 289(14), 1785-1791.
Hurling, R., Catt, M., De Boni, M., Fairley, B., Hurst, T., Murray, P., . . . Sodhi, J. (2007). Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial. Journal of Medical Internet Research, 9(2), e7.
Kaur, J. (2014). A comprehensive review on metabolic syndrome. Cardiology Research and Practice, 2014.
Kihara, S., & Matsuzawa, Y. (2015). Fat Distribution and Cardiovascular Disease Risk. Current Cardiovascular Risk Reports, 9(3), 1-6.
Lalonde, M. (1974). A new perspective on the health of canadians. Retrieved 0306, 2016, from http://www.hc-sc.gc.ca/hcs-sss/com/fed/lalonde-eng.php
Lin, C. H., Chiang, S. L., Tzeng, W. C., & Chiang, L. C. (2014). Systematic review of impact of lifestyle-modification programs on metabolic risks and patient-reported outcomes in adults with metabolic syndrome. Worldviews on Evidence-Based Nursing, 11(6), 361-368.
Lin, C. W., Yang, Y. T., Wang, J. S., & Yang, Y. C. (2012). A wearable sensor module with a neural-network-based activity classification algorithm for daily energy expenditure estimation. IEEE Transactions on Information Technology in Biomedicine, 16(5), 991-998.
Liu, Y. L., Lu, C. W., Shi, L., Liou, Y. M., Lee, L. T., & Huang, K. C. (2015). Low intensive lifestyle modification in young adults with metabolic syndrome a community-based interventional study in Taiwan. Medicine, 94(22), e916.
Lu, K. Y., Lin, P. L., Tzeng, L. C., Huang, K. Y., & Chang, L. C. (2006). Effectiveness of case management for community elderly with hypertension, diabetes mellitus, and hypercholesterolemia in Taiwan: A record review. International Journal of Nursing Studies, 43(8), 1001-1010.
Lyzwinski, L. N. (2014). A Systematic Review and Meta-Analysis of Mobile Devices and Weight Loss with an Intervention Content Analysis. Journal of Personalized Medicine, 4(3), 311-385.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., … Turner, M. B. (2015). Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation, 131(4), e29-322.
Orchard, T. J., Temprosa, M., Goldberg, R., Haffner, S., Ratner, R., Marcovina, S., & Fowler, S. (2005). The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Annals of Internal Medicine, 142(8), 611-619.
Owen, N., Healy, G. N., Matthews, C. E., & Dunstan, D. W. (2010). Too much sitting: the population-health science of sedentary behavior. Exercise and Sport Sciences Reviews, 38(3), 105.
Pan, W. H., Flegal, K. M., Chang, H. Y., Yeh, W. T., Yeh, C. J., & Lee, W. C. (2004). Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. American Journal of Clinical Nutrition, 79(1), 31-39.
Pate, R. R., O'Neill, J. R., & Lobelo, F. (2008). The evolving definition of "Sedentary". Exercise and Sport Sciences Reviews, 36(4), 173-178.
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., . . . Gale, C. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal.
Ratner, R. E., & Prevention Program Research Group, D. (2006). An update on the diabetes prevention program. Endocrine Practice, 12(Supplement 1), 20-24.
Saleh, D., & Janssen, I. (2014). Interrelationships among sedentary time, sleep duration, and the metabolic syndrome in adults. BMC Public Health, 14(1), 1.
Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA, 301(21), 2252-2259.
Taiwan Network Information Center, T. (2015). Wireless Internet Usage in Taiwan. Taipei.
The Diabetes Prevention Program Research Group. (2002). The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care, 25(12), 2165-2171.
The Diabetes Prevention Program Research Group. (2012). The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention. Diabetes Care, 35(4), 723-730.
Van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E., & Bauman, A. (2012). Sitting time and all-cause mortality risk in 222 497 Australian adults. Archives of Internal Medicine, 172(6), 494-500.
Wang, J. B., Cadmus-Bertram, L. A., Natarajan, L., White, M. M., Madanat, H., Nichols, J. F., . . . Pierce, J. P. (2015). Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial. Telemedicine Journal and e-health, 21(10), 782-792.
Wen, C. P., Wai, J. P., Tsai, M. K., & Chen, C. H. (2014). Minimal amount of exercise to prolong life: to walk, to run, or just mix it up? Journal of the American College of Cardiology, 64(5), 482-484.
Yamaoka, K., & Tango, T. (2012). Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis. BMC Medicine, 10(1), 1.
Yeh, C. J., Chang, H. Y., & Pan, W. H. (2011). Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT 1993-1996 to NAHSIT 2005-2008. Asia Pacific Journal of Clinical Nutrition, 20(2), 292-300.
Zhang, Y., Liu, Z., Yu, X., Zhang, X., Lü, S., Chen, X., & Lü, B. (2010). The association between metabolic abnormality and endometrial cancer: a large case-control study in China. Gynecologic Oncology, 117(1), 41-46.
  • 同意授權校內瀏覽/列印電子全文服務,於2018-08-01起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2018-08-01起公開。

  • 如您有疑問,請聯絡圖書館