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題名：下肢冷療耐受性與恢復特徵研究
作者：陸毅琛
作者(外文)：LU,YI-CHEN
校院名稱：中國文化大學
系所名稱：體育學系運動教練碩博士班
指導教授：彭賢德
學位類別：博士
出版日期：2021
主題關鍵詞：冷療；耐受性；安全性；運動性疲勞；恢復；動力學；Cryotherapy；Tolerance；Safety；Exercise fatigue；Recovery；Dynamics
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目的：本研究是探討局部低溫冷療對人體下肢耐受性和運動性疲勞恢復特徵。
方法：（一）運動前冷療（Pre-Exercise Cryotherapy）對人體耐受性及運動表現影響的實驗方法：31名受試者兩小腿分別接受5分鐘0℃冷敷和3分鐘-5℃冷敷，評估比較冷療前後人體成分指標（BMI、體脂率、單腿肌肉量、基礎代謝量、單腿脂肪量和單腿脂肪率、小腿圍度）、生命體徵指標（脈搏、核心體溫、呼吸頻率、血壓、冷療部位紅外Tsk和複溫時間）、下肢生物力學性能動力學指標（最大負荷和最大功率）。在冷療過程中每隔30秒記錄一次即時變數（冷療即時膚溫、疼痛指數VAS、水囊即時溫度）。冷療後進行凍傷的外科診斷。（二）運動後冷療（Post--Exercise Cryotherapy）對人體運動性疲勞恢復影響的實驗方法：10名受試者運動疲勞後雙腿分別接受-5℃冷療和自然靜置恢復，分別在運動前後6個時間點評估比較肌肉動力學指標（峰值負荷、峰值爆發力及其負荷值）、皮膚肌肉生理指標（超聲波肌肉厚度和羽狀角角度、冷療過程膚溫變化測量）、提踵高度、下肢動態平衡能力YBT，延遲性肌肉酸痛（DOMS）等。
結果：（一）運動前冷療（Pre-Exercise Cryotherapy）對人體耐受性及運動表現影響：1.-5℃組Tbladder最低為-4.1±1.14℃低於0℃組0.45±1.62℃，-5℃組Tbladder平均為-3.21±1.71℃低於0℃組1.23±2.21℃。-5℃組Tsk最低為5.33±1.53℃低於0℃組Tsk 7.64±1.93℃。Tsk與Tbladder之間的溫差，-5℃組溫差高於0℃組，且前90秒期間差異顯著P<0.05。2.寒冷痛感VAS -5℃組高於0℃組，但差異都不顯著(P>0.05)。3.Tsk與寒冷痛感VAS無顯著相關。4.年龄層次之間人體成分指標，年齡越大，人體成分越差，表現為肌肉量越少，BMI和單腿體脂率明顯低。男女之間人體成分指標差異都非常顯著P<0.001。5.生命體徵指標冷療前後總體差異不顯著（P>0.05），其中0℃組和-5℃組之間、男女之間差異也不顯著（P>0.05）。6.冷療後男女的ROI平均膚溫分別是31.18±0.73℃和30.64±0.60℃，差異顯著(P<0.01)。男女間的ROI最低膚溫和復溫時間Tre男性均稍高於女性，但沒有顯著性差異。組內男女受試者之間ROI最低膚溫Min-Tsk和複溫時間Tre男性均稍高於女性，但也沒有顯著性差異(P>0.05)。0℃組和-5℃組之間，ROI最低膚溫男性(8.76±1.57℃)高於女性(7.19±2.65℃)且差異顯著(P=0.01)。ROI平均膚溫和復溫時間-5℃組高於0℃組，但差異不顯著(P>0.05)。各年齡層次之間ROI平均膚溫和膚溫時間都沒有顯著性差異(P>0.05)。7. 冷療後凍傷外科診斷發現所有所有受試者冷療後僅有局部皮膚微紅，事後消除較快，都未發生任何程度的凍傷，且平均Tsk複溫時間：0℃組32.35±5.5 mins；-5℃組34.10±4.6 mins，-5℃組複溫時間比0℃組更長，但差異不顯著（t=-1.350，P=0.182）。8.冷療前後下肢動力學指標最大功率和最大負荷都有所提高，最大功率提高了13.77±67.00(W)，但差異不顯著P>0.05；而最大負荷提高了32.18±39.93(lb)，差異非常顯著P<0.001。Δ單腿最大功率差值0℃組24.84±50.88(W)高於-5℃組2.71±79.28(W)，差異不顯著(P>0.05)，單腿最大功率變化率來看0℃組(0.03±0.06)與-5℃組(0.03±0.09)幾乎一致。Δ單腿最大負荷差值0℃組38.58±46.08 (lb)高於-5℃組25.77±32.15 (lb)，差異不顯著(P>0.05)，單腿最大負荷變化率兩組差異也不顯著(P>0.05)。男女之間冷療前後下肢蹬伸的最大功率和最大負荷男性優於女性，差異非常顯著P<0.001。冷療導致的單腿最大功率和最大負荷的差值和變化率差異均不顯著P>0.05)。9.相關性結果：冷療前後單腿蹬伸最大功率和最大負荷分別與身高、體重、單腿小腿圍度、肌肉量都顯著正相關（P<0.01），這些相關都呈中度及以上。冷療導致的單腿最大負荷變化率與性別顯著中度正相關(r=0.304，P<0.05)，Δ單腿最大功率變化率與單腿脂肪率(r=0.283, P<0.05)、ROI皮下脂肪厚度(r=0.282, P<0.05)顯著低度正相關關。冷療前後單腿蹬伸最大功率和最大負荷冷與療前後核心體溫、呼吸頻率顯著中低度負相關，而與基礎代謝顯著高度或非常高度正相關（P<0.05），而冷療後的收縮壓與冷療前後單腿蹬伸最大功率和冷療前的最大負荷顯著低度負相關（P<0.05），而且它也與最大功率變化率、最大負荷差值、最大負荷變化率顯著低度負相關（P<0.05）。冷療後的脈搏與最大負荷差值、最大負荷變化率顯著低度負相關（P<0.05）。冷療前收縮壓（r=-0.261，P<0.05）、ROI平均膚溫（r=-0.303，P<0.05）、冷療後的基礎代謝（r=-0.255，P<0.05）分別與最大負荷變化率顯著中低度負相關。復溫時間與Δ單腿最大負荷差值顯著低度正相關（r=0.277，P<0.05）。冷療導致的ROI最低肤温與復溫時間與它沒有顯著性相關。冷療前ROI平均肤温與單腿肌肉量顯著低度正相關，而與單腿脂肪率顯著低度負相關（P<0.05）。
（二）運動後冷療（Post--Exercise Cryotherapy）對人體運動性疲勞恢復影響：1.冷療-5℃對DOMS恢復有顯著效果p=0.000，時間對DOMS恢復也有顯著效果，p=0.000。[分組*時間]在DOMS恢復上有顯著交互作用（interaction）效果，p=0.000。單純主效果檢定發現對於冷療後即刻至72小時恢復過程，冷療有顯著單純主效果。時間對於冷療組和對照組來說，也均有顯著單純主效果(p=0.0000)。2.冷療對提踵高度的恢復效果不顯著p=0.579。時間對提踵高度恢復效果顯著p=0.000。[分組*時間]在提踵高度恢復上沒有顯著交互作用（interaction）效果p=0.961。3.冷療對提大腿股直肌RF和腓腸肌內側頭MG厚度的恢復效果不顯著p>0.05。時間對它們的恢復效果顯著p<0.05。[分組*時間]在大腿股直肌和腓腸肌內側頭厚度恢復上沒有顯著交互作用（interaction）效果p>0.05。冷療、時間以及它們的交互作用對大腿股直肌RF羽狀角角度的恢復效果不顯著p>0.05。4.冷療對YBT恢復效果顯著p=0.014時間對YBT恢復效果顯著p=0.000。[分組*時間]在YBT恢復上交互作用（interaction）效果顯著p=0.000。單純主效果檢定發現對於post24、post48、post72三個時間點來說，冷療有顯著單純主效果(p<0.05)。對於冷療組和對照組來說，時間單純主效果顯著(p<0.05)。5.冷療組最大負荷顯著提高(p=0.045)，但對照組提高不顯著(p=0.087)。6. 72小時後後與事先相比，冷療組最大功率提高68.40±157.29(W)，對照組則降低了10.10±136.57(W)，但兩組的變化差異不顯著(p>0.05)。7.最大功率負荷值恢復72小時後兩組比事先pre均有所提高，但差異不顯著（冷療組P=0.323，對照組P=0.735）。組間，事先對照組高於冷療組，而恢復48小時後，冷療組反超對照組，但差異不顯著P>0.05。8.冷療組最大功率速度值恢復72小時後比事先有所提高，而對照組卻有所下降，但差異不顯著（冷療組P=0.670，對照組P=0.297）。
結論：運動後恢復應當是一個計畫周密、有控制和有管理的訓練方案的一部分。冷療處方的確定應該是因人、部位和事先運動形式的不同而區別對待，在對風險和回報有研究結果支撐的情況下精準實施冷療時間和溫度，保證安全且有效。這不僅對普通人群的運動性疲勞恢復和防止運動傷害很重要，對優秀的資深運動員提高恢復效率尤其重要。本研究不僅研發了用於運動疲勞後方便高效恢復的冷療儀，還證實了零下低溫局部冷療的安全性和有效性。
Objective: The purpose was to investigate safe tolerance and recovery characteristics of cryotherapy in lower extremity.
Methods: (1) Experimental methods for the effects of pre-exercise cryotherapy on human tolerance and performance:31 subjects received cold compress at 0℃ for 5 min and -5℃ for 3 min, respectively.Comparative evaluation of body composition indexes before and after cryotherapy (BMI, body fat rate, single leg muscle mass, basic metabolic capacity, single leg fat mass and single leg fat rate, crus surrounds degrees), vital signs index (pulse, the core body temperature, breathing rate, blood pressure, Tsk and thawing time), biomechanical performance(maximum load and maximum power).Instant variables (dynamic Tsk, VAS, dynamic Tbladder) were recorded every 30 seconds during the cryotherapy.Surgical diagnosis of frostbite after cryotherapy.(2) Experimental methods for the effect of post-exercise cryotherapy on the recovery of exercise-induced fatigue:After exercise fatigue, the legs of 10 subjects received -5℃ cryotherapy and natural static recovery, respectively.Respectively in six time points before and after more muscle dynamics index (peak load, peak power and load value), skin and muscle physiological indexes (ultrasonic thickness and pinnate muscle angle, Tsk change measurement), lift heel height, YBT,DOMS, etc.
Results: (I) Influence of pre-exercise cryotherapy on human tolerance and exercise performance:The lowest Tbladder of the -5℃ group was -4.1±1.14℃ lower than that of the 0℃ group (0.45±1.62℃). The average Tbladder of the -5℃ group was -3.21±1.71℃ lower than that of the 0℃ group (1.23±2.21℃).The lowest TSK in -5℃ group was 5.33±1.53℃, lower than that in 0℃ group was 7.64±1.93℃.The difference between Tsk and Tbladder in the -5℃ group was higher than that in the 0℃ group, and the difference was significant during the first 90 seconds P<0.05. The VAS-5 ℃ group was higher than the 0℃ group, but the difference was not significant (P>0.05).There was no significant correlation between Tsk and VAS. BMI between age levels showed the older, the worse, which was manifested as less muscle mass and significantly lower BMI and body fat percentage in one leg.The difference of body composition index between male and female was significant P<0.001. The overall difference of vital indexes before and after cryotherapy was not significant (P>0.05), there was no significant difference between 0℃ group and -5℃ group, and between male and female (P>0.05). The average ROI of men and women after cryotherapy was 31.18±0.73℃ and 30.64±0.60℃, respectively, the difference was significant (P<0.01).The minimum ROI time Tre between men and women was slightly higher in men than in women, but there was no significant difference.The Min-Tsk of ROI and rewarming time (Tre) between male and female subjects were slightly higher in males than in females, but there was no significant difference (P>0.05).Between 0 ℃ to 5 ℃ and group, Min-Tsk men (8.76±1.57℃) than women (7.19±2.65℃) and P = 0.01. The average Tsk and Tre of -5℃ group was higher than that of 0℃ group, but the difference was not significant (P>0.05). There was no significant difference in average Tsk and Tre among all age groups (P>0.05). The surgical diagnosis of frostbite after cryotherapy showed that all subjects only had local skin reddness, which was eliminated quickly afterwards, and no frostbite occurred. The average skin rewarming time was 32.35±5.5 mins in the 0℃ group, -5℃ group was 34.10±4.6 mins longer than 0℃ group, but the difference was not significant (t=-1.350, P=0.182). Both the maximum power and the maximum load of lower limb dynamics indexes were improved before and after cryotherapy, and the maximum power was increased by 13.77±67.00(W), but the difference was not significant;The maximum load increased by 32.18±39.93(lb), and the difference was significant(P<0.001). The maximum power difference of one leg in 0℃ group was 24.84±50.88(W) compared with 2.71±79.28(W) in -5℃ group, and the difference was not significant (P>0.05), the change rate of single leg maximum power in 0℃ group (0.03±0.06) and -5℃ group (0.03±0.09) was almost the same. The maximum load difference of one leg in 0℃ group was 38.58±46.08 (lb) compared with 25.77±32.15 (lb) in -5℃ group, and the difference was not significant (P>0.05), there was no significant difference in the maximum load change rate of single leg between the two groups (P>0.05).The maximum power and maximum load of lower limb extension before and after cryotherapy were better in males than in females, and the differences were significant(P<0.001).The difference between the maximum power and the maximum load and the change rate of the single leg induced by cryotherapy were not significant.(P>0.05). Correlation results: The maximum power and maximum load of single leg stretching were significantly positively correlated with height, weight, single leg circumference and muscle mass before and after cryotherapy (P<0.01), and these correlations were moderate or higher.The maximum load change rate of single leg induced by cryotherapy was positively correlated with gender (r=0.304, P<0.05), Δ single leg maximum power change rate and single leg fat percentage (r=0.283, P<0.05), ROI subcutaneous fat thickness (r=0.282, P<0.05) significantly low positive correlation.The maximum power and maximum load of single leg stretching before and after cryotherapy were significantly negatively correlated with core body temperature and respiratory rate, while highly or very highly positively correlated with basal metabolism (P<0.05), and the systolic blood pressure after cryotherapy was significantly negatively correlated with the maximum power of single leg stretch and the maximum load before and after cryotherapy (P<0.05), and it was also significantly and negatively correlated with the maximum power change rate, maximum load difference and maximum load change rate (P<0.05).The pulse after cryotherapy was negatively correlated with the maximum load difference and maximum load change rate (P<0.05).Systolic blood pressure before cryotherapy (r=-0.261, P<0.05),Average Tsk (r=-0.303, <0.05), basal metabolism after cryotherapy (r=-0.255, P<0.05) were significantly negatively correlated with the maximum load change rate.There was a significant low positive correlation between the reheating time and theΔmaximum load difference (r=0.277, P<0.05).The lowest Tsk and rewarming time had no significant correlation with it.The average Tsk before cryotherapy was significantly positively correlated with muscle mass in one leg, and negatively correlated with fat percentage in one leg (P<0.05).
(2) Effect of post-exercise cryotherapy on the recovery of exercise-induced fatigue: cryotherapy at -5℃ has a significant effect on the recovery of DOMS (P =0.000), and time also has a significant effect on the recovery of DOMS (P =0.000).[Group * Time] There is significant interaction effect on the recovery of DOMS, P =0.000.The simple main effect test showed that cryotherapy had significant main effect on the recovery process from immediate to 72 hours after cryotherapy.Time also had significant primary effect on both the cryotherapy group and the control group (P =0.0000).The recovery effect of cryotherapy on heel height was not significant P =0.579.The recovery effect of time on heel height was significant P =0.000.[Grouping * time] had no significant interaction effect on heel height recovery P =0.961.The recovery effect of cryotherapy on the RF of rectus femoris and the Mg thickness of the medial head of gastrocnemius was not significant,p>0.05.The effect of time on their recovery was significant,p<0.05.There was no significant interaction effect on the recovery of thickness,p>0.05.The effect of cryotherapy, time and their interaction on the recovery of RF pinnate Angle of thigh rectus femoris muscle was not significant,p>0.05.4. cryotherapy has significant effect on YBT recovery ,P =0.014. Time has significant effect on YBT recovery ,P =0.000.[Grouping * time] significant interaction effect on YBT recovery ,P =0.000.For post24, post48, post72 time points, cryotherapy had a significant main effect (P<0.05).For both the cryotherapy group and the control group, the main effect of time alone was significant (P<0.05).The maximum load was significantly increased in the cryotherapy group (P =0.045), but not significantly increased in the control group (P =0.087). After 72 hours, the maximum power of the cryotherapy group was increased by 68.40±157.29(W), while that of the control group was decreased by 10.10±136.57(W), but there was no significant difference between the two groups (P>0.05). After 72 hours of maximum power load recovery, both groups were improved compared with pre-PRE, but the difference was not significant (P=0.323 in the cryotherapy group and P=0.735 in the control group).Among groups, the control group was higher than the cryotherapy group, but the cryotherapy group was higher than the control group after 48 hours recovery, but the difference was not significant(P>0.05). After 72 hours of recovery, the maximum power speed value of the cryotherapy group was increased compared with that of the control group, while the value of the control group was decreased, but the difference was not significant (P=0.670) in the cryotherapy group and(P=0.297) in the control group.
Conclusion: Post-exercise recovery should be part of a well-planned, controlled and managed training program.The determination of cryotherapy prescription should be treated differently according to different people, parts and prior exercise forms, and the precise implementation of cryotherapy time and temperature should be supported by research results on risks and returns to ensure safety and effectiveness.It is important not only for the general population to recover from sports fatigue and prevent sports injury, but also for the elite senior athletes to improve the recovery efficiency.This study not only developed a cryotherapy instrument for convenient and efficient recovery after exercise fatigue, but also confirmed the safety and effectiveness of sub-zero low temperature local cryotherapy.
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