1、運動對智障人士精神健康的關係與影響,黃宗顯醫生 (Dr Wong Chung Hin Willy)精神科專科醫生英國皇家精神科醫學院院士香港精神科醫學院院士香港醫學專科學院院士(精神科)香港大學李嘉誠醫學院名譽臨床助理教授17 October 2015,體育鍛鍊,一般人都普遍認同體育活動對心理健康有益處智障人士的群體一般都不被包括在大規模的研究中，因而他們體育活動的模式可能被忽視或不被研究References: Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits
2、 associated with physical activity. Current Opinion in Psychiatry. 2005; 18: 189-193.Temple VA, Frey GC, Stanish HI. Physical activity of adults with mental retardation. Review and research needs. American Journal of Health Promotion. 2006; 21: 2-12.,智障人士的特徵,智障人士沒有決心參加任何運動鍛煉 原因：運動神經活動減少行為障礙 專注力不足溝通技
3、巧欠佳超重或肥胖的風險增加(輕度至中度智障風險較高）Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of cognitive function, BDNF, IGF-1, and VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,水中健身(Aquatic Exercise),水中健身,提高運動鍛煉的效率克服因身體殘障引致的尷
4、尬及不安的感覺 Reference: Lim IS, JW Chan. The effects aquatic training on physical function, information processing ability, and blood lipid in stroke patients. Korean Journal of Physical Education. 2003; 42(4): 647-654.,水中訓練計劃,研究方法,15名男性智障人士進行水上訓練計劃及經顱微電流刺激療法(CES cranial electrotherapy stimulation)維期12星期
5、於復康中心進行研究對象分為3個小組 (對照組、運動組、運動加CES 組)Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of cognitive function, BDNF, IGF-1, and VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,血液分析,BDNF (腦源性神經因子 Brain-derived neuro
6、trophic factor)IGF-1 (胰島素樣生長因子 Insulin-like growth factor)VEGF (血管內皮生長因子 Vascular endothelial growth factor)這些因子可以增加神經元細胞抗死亡的能力，並促使腦血管的生長及神經的組成 在治療前後於休息狀態下從手臂血管採集血液樣本 Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of cognitive function, BDNF, IGF-1, a
7、nd VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,研究認知功能測試,K-WAB (Korean Western Aphasia Battery)WAB (Western Aphasia Battery)測試項目：口語測試書面語言測試運動測試 Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of cognitive fu
8、nction, BDNF, IGF-1, and VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,研究結果,在三個組別中，運動組與運動加CES組的認知功能值明顯較對照組增加 (p 0.05)運動組與及運動加CES組的BDNF及VEGF的濃度顯著增加 (p 0.05)Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of co
9、gnitive function, BDNF, IGF-1, and VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,總結,運動有助智障人士的認知功能 BDNF 能夠刺激腦細胞的生長VEGF 加速了內皮細胞的生長Reference: Lee IH, Seo EJ, Lim IS. Effects of aquatic exercise and CES treatment on the changes of cognitive function, BDNF, IGF
10、-1, and VEGF of persons with intellectual disabilities. J Exerc Nutr Biochem. 2014; 18(1): 19-24.,瑜伽練習(Yoga Exercise),瑜伽的好處,對抑鬱症、創傷後壓力心理障礙症及精神分裂症等精神障礙具治療效果。References: Lavey R, Sherman T, Mueser KT, Osborne DD, Currier M, Wolf R. The effects of yoga on mood in psychiatric inpatients. Psychiatr Rehab
11、il J. 2005; 28: 399-402.Shapiro D, Cook IA, Davydov DM, Ottaviani C, Leuchter AF, Abrams M. Yoga as a complementary treatment of depression: Effects of traits and moods on treatment outcome. Evid Based Complement Alternat Med. 2007; 4: 493-502.Visceglia E, Lewis S. Yoga therapy as an adjuctive treat
12、ment for schizophrenia: A randomized, controlled pilot study. J Altern Compliment Med. 2011; 17: 601-7.,研究方法,多基線設計 (Multiple baseline design)2名年青輕度智障人士 (女：21歲；男：22 歲) (IQ 71； 75)第一組 : 非結構性的運動時間第二組 : 結構性的瑜伽課程 一小時瑜伽小組由具經驗的瑜伽導師教授由導師按瑜伽流 (Vinyasa) 方法為初學至資深學員設計循序漸進及適應性課程，學習正宗的瑜伽體式 (Asanas)Reference: Hawk
13、ins BL, Stegall JB, Weber MF, Ryan JB. The influence of a yoga exercise program for young adults with intellectual disabilities. International Journal of Yoga. 2012; 5: 151-156.,參數,運動行為的頻率用力的感知水平參與者的滿意程度 Reference: Hawkins BL, Stegall JB, Weber MF, Ryan JB. The influence of a yoga exercise program f
14、or young adults with intellectual disabilities. International Journal of Yoga. 2012; 5: 151-156.,研究結果,瑜伽的社會效益：智障學生能夠與其他參與瑜伽課程的非殘障人士和大學生有簡短的交談從軼事證據 (Anecdotal evidence) 中了解參加課程得到的社會效益 Reference: Hawkins BL, Stegall JB, Weber MF, Ryan JB. The influence of a yoga exercise program for young adults with
15、intellectual disabilities. International Journal of Yoga. 2012; 5: 151-156.,迷你網球(Mini Tennis),迷你網球,經改良的網球運動適合青少年、兒童及殘障人士採用輕量柔軟的球和短柄輕量球拍在較一般標準網球場小一半的場地進行球和球拍的尺寸適合運動員的需要 Reference: Hardoy MC, Seruis ML, Floris F, Sancassiani F, Moro MF, Melllino G, Lecca ME, Adamo S, Carta MG. Benefits of exercise wit
16、h mini tennis in intellectual disabilities: effects on body image and psychopathology. Clinical Practice 7: 157-160.,迷你網球,第一階段：練習，熟悉各運動設備：網球、木質短槳、球拍第二階段： 發展身體協調的能力：視覺手動、一般動作 及 時間空間技能第三階段： 學習基本的網球技巧Reference: Hardoy MC, Seruis ML, Floris F, Sancassiani F, Moro MF, Melllino G, Lecca ME, Adamo S, Carta
17、 MG. Benefits of exercise with mini tennis in intellectual disabilities: effects on body image and psychopathology. Clinical Practice 7: 157-160.,迷你網球,運動比賽前的結構性訓練假設：能夠刺激社教化的過程和提高自尊感，對心理社會的技能有正面的影響提高情緒和生理的生活質素 Reference: Hardoy MC, Seruis ML, Floris F, Sancassiani F, Moro MF, Melllino G, Lecca ME, Ad
18、amo S, Carta MG. Benefits of exercise with mini tennis in intellectual disabilities: effects on body image and psychopathology. Clinical Practice 7: 157-160.,研究方法,臨床對照試驗兩組各12名的參與者 (實驗組和對照組)年齡介乎18-40 歲的輕度至中度智障人士評估在接受半院舍式照顧的輕/中度智障學員在參與治療式的迷你網球基礎訓練班對心理社會的康復治療功效量度的時間是起始點、2個月和6個月評估工具：The Italian version
19、of the Assessment and Information Rating ProfileReference: Hardoy MC, Seruis ML, Floris F, Sancassiani F, Moro MF, Melllino G, Lecca ME, Adamo S, Carta MG. Benefits of exercise with mini tennis in intellectual disabilities: effects on body image and psychopathology. Clinical Practice 7: 157-160.,研究結
20、果,數字顯示實驗組的心理病理總分 (psychopathological total scores) 較對照組有明顯的減少焦慮分量表 (anxiety sub-scale) 的總分顯著減少在精神分裂症 (schizophrenia)、抑鬱症(depression)、適應障礙 (adjustment disorder)、人格障礙 (personality problems)、軀體形式障礙(somatoform disorders) 及性心理障礙(psychosexual disorders) 的總分沒有顯著差異改善視覺手動協調能力及提高參與者的自尊Reference: Hardoy MC, Se
21、ruis ML, Floris F, Sancassiani F, Moro MF, Melllino G, Lecca ME, Adamo S, Carta MG. Benefits of exercise with mini tennis in intellectual disabilities: effects on body image and psychopathology. Clinical Practice 7: 157-160.,體育運動對挑戰行為(Challenging Behavior) 的影響,挑戰行為,攻擊行為 (Aggressive behaviour) 重覆的動作及
22、行為 (Stereotypal behaviour)自傷行為 (Self-injurious behavior)過度活躍行為 (Hyperactivity),研究,有系統的文獻綜述二十個研究運動對智障人士挑戰行為影響的調查Reference: Ogg-Groenendaal M, Hermans H, Claessens B. A systematic review on the effect of exercise interventions on challenging behavoiur for people with intellectual disabilities. Researc
23、h in Developmental Disabilities. 2014; 35: 1507-1517.,結果,參與運動後挑戰行為顯著減少高或低強度的運動因素無顯著差異推薦為一種對智障人士挑戰行為有效的治療方法Reference: Ogg-Groenendaal M, Hermans H, Claessens B. A systematic review on the effect of exercise interventions on challenging behavoiur for people with intellectual disabilities. Research in
24、Developmental Disabilities. 2014; 35: 1507-1517.,體育運動對焦慮症(Anxiety) 的影響,焦慮症,智障人士經常被描述具高度焦慮的特徵Reference: Stravakaki C, Lunsky Y. Depression, anxiety and adjustment disorders in people with developmental disabilities. In N Bouras (Ed.), Psychiatric and behavioural disorders in intellectual and developm
25、ental disorders (pp.113-130). Cambridge, UK: Cambridge University Press,研究方法,27位研究對象輕度至中度智障人士隨機安排參與運動組或對照組對照組進行繪畫活動為期12週的運動計劃以研究運動對焦慮狀態的影響評估工具：Zung Self-Rating Anxiety ScaleState-Trait Anxiety Inventory Form YReference: Carraro A, Gobbi E. Effects on an exercise programme on anxiety in adults with i
26、ntellectual disabilities. Research in Developmental Disabilities. 2012; 33: 1221-1226.,運動,運動專家推行訓練計劃兩位導師協助令每位參加者可以有更好的參與以小組活動形式進行運動的強度和時間配合參加者的技能和體能情況初步熱身運動，中段（主要項目，設備包括球類、繩、啞鈴）和緩和運動Reference: Carraro A, Gobbi E. Effects on an exercise programme on anxiety in adults with intellectual disabilities. R
27、esearch in Developmental Disabilities. 2012; 33: 1221-1226.,研究結果,相對於參加靜態活動的一組，運動組的焦慮評分隨時間而有顯著的減少運動可以被認為是促進智障人士心理健康的有 效策略將運動帶入生活模式的方法是促進個人健康和福祉具成本效益的策略Reference: Carraro A, Gobbi E. Effects on an exercise programme on anxiety in adults with intellectual disabilities. Research in Developmental Disabil
28、ities. 2012; 33: 1221-1226.Verhaeghe N, De Maeseneer J, Maes L, Van Heeringer C, Annemans L. Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: A systematicreview. International Journal of Behavioural Nutrit
29、ion and Physical Activity. 2011; 8: 1-12.,需要多少的體育運動？,短時間的運動比長時間的運動有更好的效果每週運動 4 次比每週 3 次的效果更理想最有效的運動時間是 31-60 分鐘運動對年長者較年輕人更有效Reference: Shin IS, Eun-Young P. Meta-analysis of the effect of exercise programs for individuals with intellectual disabilities. Research in Developmental Disabilities. 2012; 33: 1937-1947.,世界衛生組織 (2010) 身體活動的建議,總結,體能運動對智障人士的精神健康影響的研究仍然有限證據 (Anecdotal evidence) 顯示體育鍛煉對智障人士有益處（包括改善認知功能、社教化、自尊、減少挑戰行為、焦慮和其他精神障礙)可考慮的項目包括水上運動、瑜伽、小型網球等建議智障人士應參與體能運動,隱在你身邊的精神病患亮光文化,多謝！Thank You,Email: ,
