以「自我決定理論」為基礎之運動方案改善精神疾病患者之心理健康與生理代謝功能的成效研究: 隨機臨床試驗

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Title:	以「自我決定理論」為基礎之運動方案改善精神疾病患者之心理健康與生理代謝功能的成效研究: 隨機臨床試驗
Authors:	馬維芬(Wei-Fen Ma);藍先元(Hsien-Yuan Lane);蔣立琦(Li-Chi Chiang);鄭光甫(Kuang-Fu Cheng)
Contributors:	健康照護學院護理學系;中國附醫護理部
Date:	2012-07-31
Issue Date:	2012-06-15 11:49:02 (UTC+8)
Abstract:	以「自我決定理論」為基礎之運動方案改善精神疾病患者之心理健康與生理代謝功能的成效研究: 隨機臨床試驗從最近的文獻與臨床實務中發現，精神疾病患者的代謝症候群特徵不斷被提出討論而成為一個重要的照護目標。代謝症候群的產生除生活型態改變外，亦受到服用第二代抗精神疾病藥物副作用的影響，病患不只受到心理健康的煎熬，亦受到身體健康的威脅，而規律的運動正好有效強化心理健康並降低代謝症候群的發生。但是台灣民眾除較低的規律運動參與率外，亦少有實證資料提供針對精神疾病患者的運動方案的成效，因此，近2年的相關研究依據一個針對高焦慮的台灣成年人所測試的運動影響模型，來設計出針對焦慮症患者的運動方案，雖然結果呈現明顯地正面效果，但因個案缺乏動機出現的高比例退出，嚴重影響研究成效的評估。自我決定理論是一個被許多健康與運動專家所推薦用來增加動機於促進規律運動習慣的理論。因此，本研究針對罹患精神疾病患者，設計一套為期12週的新運動方案(SPEP)，此方案依據自我決定理論的概念來修改原針對焦慮患者設計的運動方案。研究目的為評值以「自我決定理論」為基礎之運動方案改善精神疾病患者之心理健康與生理代謝功能的成效。以隨機臨床試驗的設計來評量短中長期的成效，以中部五個門診被診斷為精神疾病患者為個案，實驗組接受傳統護理照護與SPEP方案，控制組將接受傳統護理照護，並在研究結束後接受SPEP方案。心理的健康與生理代謝控制的指標將由七個問卷以及生理機器測量，並分別於前測，前測後三、六、十二、以及十八等月評估。研究結果將提供具有意義的知識於由護理為管理者之運動方案促進精神疾病患者的生理與心理健康，同時，亦提供良好護理措施介入協助精神疾病患者面臨代謝症候的健康問題。 The effectiveness of exercise program based on “self-determination theory” in improving metal health and metabolic control functions for patients with mental illness: a randomized clinical controlled trial The serious health issues of metabolic status in patients with mental disorders were emphasized recently in literature and mental health nursing clinical practice. Patients with psychiatric disorders suffer from health problems not only mentally, but also physically. The major mental disorders are associated with an increased risk for obesity-related cardiovascular mortality, including use of atypical antipsychotic agents with high metabolic risk. Exercise/ regular physical activity has been shown to be an effective intervention to improve physical and psychological functions. However, limitations were found including high prevalence of inactivity for Taiwanese people and few exercise programs designed for patients with mental disorders. Previous study designed an exercise program for patients with anxiety disorders in a 2-year research based on PAPA model tested in population of higher levels of state and trait anxiety. The positive outcomes were found but lacking motivations toward adopting and maintaining a regular exercise lifestyle becomes a serious problem for improving patients’mental and physical health. The Self-Determination Theory has been used as a framework for promoting regular exercise/ physical activity in many research suggested by health and exercise professionals. Evidence showed that motivations were associated with greater frequency of weekly exercise participation. Consequently, this study designs a new 12-week exercise program (SPEP) for patients with diversity of mental disorders based on Self-Determination Theory from the original one. The purpose of this study is to evaluate the effectiveness of SPEP exercise intervention for improving metal health and metabolic control functions for patients with mental disorders. The randomized clinical controlled trial will be used to evaluate short- and long-term effectiveness of exercise program. Study participants with diagnosis of psychiatric disorders will be recruited from 5 clinics in middle area of Taiwan. Subjects in experimental group receive both exercise intervention and traditional nursing care. Seven self-report scales and physiologic assessment will evaluate the outcomes variables of general mental health and metabolic control functions at the baseline and 3, 6, 12 and 18 months after baseline. Data will be analyzed major by Mix model analysis. The results of this study will provide significant knowledge in mental health nurses to be a core health manager in exercise programs for improving patients’mental and physical health. Meanwhile, metabolic status problems of patients with psychiatric disorders may be deal with suitable and effective nursing interventions.
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