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9.循環器系の疾患 （I251
㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ෙື⬦ᝈ㸧 ᩥ⊩ Manchanda SC, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. JAssoc Physicians India.2000; 48(7): 687-94. Pubmed ID:11273502 ┠ⓗ ࣚ࢞ࣛࣇࢫࢱࣝධࡼࡗ࡚ෙື⬦ࡢື⬦◳ࡢࡼ࠺࡞ຠᯝࡀᚓࡽࢀࡿࢆㄪ ࡿࠋ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ " ཧຍ⪅ ෙື⬦㐀ᙳ᳨ᰝ࡛ド᫂ࡉࢀࡓෙື⬦ᝈᝈ⪅ ྡs ධ ࣚ࢞ࣛࣇࢫࢱ࣓ࣝࢯࢵࢻࣚ࢞ࠊࣜࢫࢡࣇࢡࢱ࣮⟶⌮ࠊ⮬ไࢲ࢚ࢵࢺࠊ㐺ᗘ࡞࢚ ࣟࣅࢡࢫ ึࡵᅾᆺࣚ࢞ࢭࣥࢱ࣮࡛ኵ፬ඹ ᪥㛫㐣ࡈࡋࣚ࢞ࢆయ㦂ࡍࡿࠋࡑࡢᚋ ⮬Ꮿᐇ⩦㸸 ศ ᪥ ᖺ㛫ࠋ 㐌㛫୍ᗘኵ፬࡛ࢭࣥࢱ࣮ࢆゼࢀࠊᐇ⩦ሗ࿌ࢆࡍࡿࠋ $UPධ⩌ࣚ࢞⩌ Q $UPࢥࣥࢺ࣮ࣟࣝ⩌ᚅᶵ⩌ Q $+$VWHS ࡢ㣗⟶⌮ࠊࣜࢫࢡࣇࢡࢱ࣮⟶⌮ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 1 㐌㛫ᙜࡓࡾࡢ⊃ᚰ≧ࠊయ㔜ࠊࢥࣞࢫࢸ್࣮ࣟࣝࠊLDLࠊTGࠊHDLࠊ㐠ື㛫ࠊ㐠 ື㈇Ⲵࡢ ST ୖ᪼ࡢ᭷↓ࠊෙື⬦ኚࡢ㔜ᗘࠊࢆධ๓ධᚋ㸦୍ᖺᚋ㸧᳨ᰝࠋ ࡞⤖ᯝ ධ⩌࡛ࡣࢥࣥࢺ࣮ࣟࣝ⩌ẚ୍࡚㐌㛫㉳ࡇࡿ⊃ᚰ≧ࡢᅇᩘࡢ᭷ព࡞ῶᑡࠊ㐠ື ࡢ⪏ᛶࠊయ㔜ࡢῶᑡࡀㄆࡵࡽࢀࡓࠋࡲࡓࠊ⥲ࢥࣞࢫࢸ್࣮ࣟࣝࠊLDL ್ࠊTG ್ࡶࢥࣥ ࢺ࣮ࣟࣝ⩌ẚ࡚᭷ព࡞ῶᑡࢆㄆࡵࡓࠋHDL ࡣᕪࡀ࡞ࡗࡓࠋෙື⬦ᙧᡂ⾡ࡸࣂࣃ ࢫ⾡࠸ࡗࡓᡭ⾡ࢆ⾜࠺㢖ᗘࡶࣚ࢞ࢢ࣮ࣝࣉ࡛ࡣᑡ࡞ࡗࡓ㸦p=0.01㸧 ࠋ㸯ᖺᚋࡢෙື⬦ 㐀ᙳ᳨ᰝ࡛ࠊࣚ࢞⩌࡛ࡣࢥࣥࢺ࣮ࣟࣝ⩌ࡼࡾࠊ㏥⦰ࡋࡓኚࡀከࡃࠊ㐍⾜ࡋࡓኚࡣᑡ࡞ ࡗࡓࠋ ⤖ㄽ ࣚ࢞ࣛࣇࢫࢱࣝࡢᑟධࡣෙື⬦ᝈࡢᝈ⪅ࡢື⬦◳ࡢ㐍⾜ࢆ㐜ࡽࡏࠊᚋ㏥ࢆ᪩ࡵࡿ ࡇࡀ᫂ࡽ࡞ࡗࡓࠋࡲࡓࠊ≧(symptomatic status)ࡸᶵ⬟(functional class)ࠊࣜࢫࢡ㸦risk factor profile㸧ࡶᨵၿࡍࡿࡇࡀศࡗࡓࠋ Ᏻᛶ㛵ࡍࡿゝཬ ᅇࡢධᑐࡍࡿࢥࣥࣉࣛࣥࢫࡣ㠀ᖖࡼࡃࠊస⏝ࡢሗ࿌ࡶㄆࡵࡽࢀ࡞ࡗࡓࠋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ グ㏙࡞ࡋ ࣚ࢞ࡢヲ⣽ ࣚ࢞ࣛࣇࢫࢱ࣓ࣝࢯࢵࢻࡢࣚ࢞㸸ࢫࢺࣞࢵࢳࠊ྾ἲࠊ࣮ࢧࢼࠊࣜࣛࢡࢮ ࣮ࢩ࢚ࣙࣥࢡࢧࢧࢬ࡞ᘱ⦆ࠊ▂㸦3UHNVKD㸧 ࠊ⇍⪃$QXYUDW㸤$QXSUHNVKDࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ࣚ࢞ࡢᑟධࡀෙື⬦ᝈࡢᝈ⪅ᑐࡋ࡚᭷ຠ࡛࠶ࡿࡇࡀ♧၀ࡉࢀࡿࠋᗘࡣලయⓗࣚ ࢞㐠ືࡀᚠ⎔ჾ⣔ࡸ⾑⟶ࡢࡼ࠺࡞స⏝ࢆཬࡰࡋ࡚࠸ࡿࡢࡘ࠸࡚ࡢ◊✲ࡀᮇᚅࡉ ࢀࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ෙື⬦ᝈᝈ⪅ᑐࡋ࡚ࣚ࢞ࡢࣛࣇࢫࢱࣝࢆ່ࡵࡿࠋ $EVWUDFWRUDQG'DWH ᒸభ ᒸᏕ − 159 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ෙື⬦ᝈ㸧 ᩥ⊩ Mahajan AS, et al : Lipid profile of coronary risk subjects following yogic lifestyle intervention. Indian Heart J. 1999 jan-feb; 51(1): 37-40. Pubmed ID:10327777 ┠ⓗ ⊃ᚰࡢ᪤ ࡢ࠶ࡿෙື⬦ᝈᝈ⪅ෙື⬦༴㝤ᅉᏊಖ᭷⪅ᑐࡍࡿࠊࣚ࢞ⓗ⏕άࢫ ࢱࣝධࡢ⾑Ύ⬡㉁ཬࡰࡍຠᯝࢆホ౯ࡍࡿ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ ≉グ㏙࡞ࡋ ཧຍ⪅ ෙື⬦ᝈᝈ⪅༴㝤ᅉᏊಖ᭷⪅ࡢ⏨ᛶ ྡ ṓ ධ ࣚ࢞ⓗ⏕άࢫࢱࣝࣉࣟࢢ࣒ࣛ ᅇ ศ ᪥㛫ࡢࣚ࢞࢟ࣕࣥࣉᚋࠊ⮬Ꮿᐇ⩦ࢆẖ᪥ 㐌㛫⾜࠺ $UPධ⩌ࣚ࢞ⓗ⏕άࢫࢱࣝ⩌ ྡ $UPࢥࣥࢺ࣮ࣟࣝ⩌ᚅᶵ⩌㸦ࣛࣇࢫࢱࣝࢻࣂࢫࡣ୧⩌⾜࡞࠺㸧 ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ య㔜ࠊ⾑Ύࢥࣞࢫࢸ࣮ࣟࣝࠊࢺࣜࢢࣜࢭࣜࢻࠊHDLࠊLDLࠊཬࡧࢥࣞࢫࢸ࣮ࣟࣝ-HDL ẚ ࢆධ๓ࠊ4 㐌ࠊ10 㐌ࠊ14 㐌ࡢ 4 ᅇ ᐃࠋ ࡞⤖ᯝ ⩌ෆẚ㍑㸸ࣚ࢞⩌࡛ࡣࠊᚰ⾑⟶ࣜࢫࢡᝈ⪅࡛ࡶ⊃ᚰᝈ⪅ࡶࠊ14 㐌ᚋࠊయ㔜ࠊࢥࣞ ࢫࢸ࣮ࣟࣝࠊࢥࣞࢫࢸ࣮ࣟࣝ-HDL ẚࠊLDLࠊࢺࣜࢢࣜࢭࣜࢻࡣపୗࡋࠊHDL ࡣቑຍࡋࡓࠋ ࡇࡢഴྥࡣࡳࡽࢀࠊ10 㐌ࡽࡇࡢഴྥࡣࡳࡽࢀࡓࠋᚅᶵ⩌࡛ࡣ 14 㐌ᚋࠊࡇࢀࡽࡢࣃ࣓ࣛ ࣮ࢱ࣮ኚࡣࡳࡽࢀ࡞ࡗࡓࠋ ⩌㛫ẚ㍑㸸◊✲㛤ጞࡣ୧⩌ᕪࡣ࡞ࡗࡓ 14 㐌ᚋ࡛ࡣࠊࣚ࢞⩌ࡢᚰ⾑⟶ࣜࢫࢡᝈ⪅ ࡛ࡣࢥࣞࢫࢸ࣮ࣟࣝࠊࢥࣞࢫࢸ࣮ࣟࣝ-HDL ẚࠊLDL ࡀᚅᶵ⩌ࡼࡾపࡃࠊHDL ࡣ㧗ࡗ ࡓࠋࢺࣜࢢࣜࢭࣜࢻࡣ୧⩌࡛ᕪࡀ࡞ࡗࡓࠋࣚ࢞⩌⊃ᚰᝈ⪅࡛ࡶࢥࣞࢫࢸ࣮ࣟࣝࠊࢥࣞ ࢫࢸ࣮ࣟࣝ-HDL ẚࠊLDLࠊࢺࣜࢢࣜࢭࣜࢻࡀᚅᶵ⩌ࡼࡾపࡗࡓࡀࠊHDL ࡣ୧⩌࡛ᕪࡀ ࡞ࡗࡓࠋ ⤖ㄽ ࣚ࢞ⓗ⏕άࡼࡾ⬡㉁≧ែࡀᨵၿࡋࡓࠋࣚ࢞ⓗ⏕άࡀෙື⬦ᝈᑐࡋ࡚ண㜵ⓗ࠾ࡼࡧ ⒪ⓗ᭷┈࡞ຠᯝࢆⓎࡍࡿࡇࢆㄝ᫂ࡍࡿࡔࢁ࠺ࠋ Ᏻᛶ㛵ࡍࡿゝཬ ࡞ࡋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ グ㏙࡞ࡋ ࣚ࢞ࡢヲ⣽ ࣚ࢞ⓗ⏕άࢫࢱࣝࣉࣟࢢ࣒ࣛ㸸ࣉࣟࢢ࣒ࣛࡣࠊࣚ࢞ࡢⱝ㏉ࡾࡢࣉࣛࢡࢸࢫࠊࢫࢺࣞࢵ ࢳࡢ࣮ࢧࢼࠊࣉ࣮ࣛࢼ࣮࣮࣐ࣖࠊSUHNVKD ࡢࢹ࣮ࣖࢼࠊ▂㐍⾜ᛶ➽ᘱ⦆㸦㸸 .D\RWVDUJ㸧ࡽᵓᡂࡉࢀ࡚࠸ࡓࠋ㸨ࠊప⬡⫫ࠊ㤶㎞ᩱ࡞ࡋࡢ࣋ࢪࢱࣜࣥ⏝ࡢ㣗ࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ᮏ◊✲࡛ࡣࣚ࢞ⓗ⏕άࡢ୰࣋ࢪࢱࣜࣥࡢ㣗ࢆࡍࡿࡇࡀྵࡲࢀ࡚࠾ࡾࠊࡶࡋࡋࡓ ࡽ㣗せᅉࡀ⤖ᯝࡁࡃᙳ㡪ࡋ࡚࠸ࡿࡶࡋࢀ࡞࠸ࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ⊃ᚰࡸෙື⬦ᝈ༴㝤ᅉᏊಖᣢ⪅ᑐࡋ࡚ࣚ࢞ⓗ⏕ά㸦㣗ࢆྵࡴ㸧ࢆ່ࡵࡿࠋ $EVWUDFWRUDQG'DWH ụ⏣⪽Ꮚ ᒸᏕ − 160 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ᚰ㸧 ᩥ⊩ Krishna BH et al: A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure. Integrative Medicine Insights 2014;9,1-6. Pubmed ID:24737932 ┠ⓗ ᶆ‽ⓗ࡞⸆≀⒪ἲే⏝ࡋࡓࣚ࢞ࡢࢺ࣮ࣞࢽࣥࢢࡀࠊᚰ㸦+)㸧࠾ࡅࡿᚰᶵ⬟ࢆᨵၿ ࡋࠊ1 ᮎ➃ࣉࣟ % ᆺࢼࢺ࣒ࣜ࢘ᒀ࣌ࣉࢳࢻ㸦17SUR%13㸧ࢆῶࡽࡍࡇࡀ࡛ࡁࡿ࠺ ࢆホ౯ࡍࡿ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ 7KH$GYDQFHG&HQWUHIRU<RJD7KHUDS\(GXFDWLRQDQG5HVHDUFK-DZDKDUODO ,QVWLWXWHRI3RVWJUDGXDWH0HGLFDO(GXFDWLRQDQG5HVHDUFKࣥࢻ ཧຍ⪅ ேࡢᚰᝈ⪅ ධ 6<$6$ࣚ࢞⒪ἲ ᅇ ศ 㐌㛫ࠊࡑࡢᚋ⮬Ꮿ࡚ ᪥㛫ࢆྜィ 㐌㛫 $UPධ⩌⸆≀⒪ἲ㸩ࣚ࢞⩌ ྡ $UPࢥࣥࢺ࣮ࣟࣝ⩌⸆≀⒪ἲ⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ ᚰᶵ⬟ࡣࠊ1.LVEF(ᕥᐊ㥑ฟ⋡ )2.Tei Index(ᚰ➽ࣃࣇ࢛࣮࣐ࣥࢫ࣭ࣥࢹࢵࢡࢫ) 3.NT pro BNP(ᚰࡢࣂ࣐࣮࣮࢜࢝)ࠊධ๓ࠊ12 㐌ᚋẚ㍑ ࡞⤖ᯝ ධ๓ࠊୖグࡢࣃ࣓࣮ࣛࢱ࣮ࡣ୧⩌࡛ᕪࡀ࡞ࡗࡓࠋධ๓ᚋ࡛ࡢ⩌ෆẚ㍑࡛ࡣࠊ୧⩌࡛ LVEF ࡣቑຍࡋࠊTei index NT pro BNP ࡣῶᑡࡋࡓ㸦P㸺0.05 ࡶࡋࡃࡣ 0.01㸧 㸦୧⩌ࡶ ᚰࡣᨵၿࡋࡓ㸧 ࠋධᚋࡢ⩌㛫ẚ㍑࡛ࡣࠊLVEF ࡣࣚ࢞⩌࡛ 36.88%ࡢቑຍࠊࢥࣥࢺࣟ ࣮ࣝ⩌࡛ 16.9%ࡢቑຍࠊTei index ࡣࣚ࢞⩌࡛ 27.87%ࡢῶᑡࠊࢥࣥࢺ࣮ࣟࣝ⩌࡛ 2.79%ࡢῶ ᑡ ࠊNT pro BNP ࡣࣚ࢞⩌࡛ 63.75%ࡢῶᑡࠊࢥࣥࢺ࣮ࣟࣝ⩌࡛ 10.77%ࠊࣚ࢞⩌ࡢᨵၿ ࡢ᪉ࡀ᭷ព㢧ⴭ࡛࠶ࡗࡓ㸦p<0.01㸧 ࠋ ⤖ㄽ ࡇࡢ◊✲ࡣࠊᏳᐃࡋࡓᚰᝈ⪅࠾࠸࡚ᶆ‽ⓗ࡞⸆≀⒪ἲຍ࠼࡚ 12 㐌㛫ࡢࣚ࢞⒪ἲ ࢆ⾜࡞࠺ࠊࡼࡾᚰᶵ⬟ࡣᨵၿࡋࠊᚰ➽ࢫࢺࣞࢫࡣᨵၿࡍࡿࢆᐇドࡋࡓࠋ Ᏻᛶ㛵ࡍࡿゝཬ ࣚ࢞ࡢࢭࢵࢩࣙࣥ୰ࡲࡓࡣࢭࢵࢩࣙࣥ㛵㐃ࡋ࡚ࠊᚰ⮚ࡢ≧㸦ᜥษࢀࠊࡩࡽࡘࡁ㸧ࡸᚰ ⮚ࡢၥ㢟ࠊᩚᙧእ⛉ⓗ࡞᭷ᐖ㇟ࡣ࡞ࡗࡓࠋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ධ⩌㸣 ࢥࣥࢺ࣮ࣟࣝ⩌㸣 ୧⩌ඹ⌮⏤ࡣ᫂ ࣚ࢞ࡢヲ⣽ ࣮ࣝࢬࢽࣥࢢ࢚ࢡࢧࢧࢬ ࣮ࢧࢼ ✀㢮 ▂ ྾ἲ $80 ࢳࣕࣥࢸ ࣥࢢ ࢩࣕࣂ࣮ࢧࢼ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ࣚ࢞ࡢ࣮ࢧࢼࡸࣉࣛࢼ࣮࣮࣐ࣖࠊࣜࣛࢡࢭ࣮ࢩࣙࣥࡢࡼ࠺࡞ᙧᘧࡢ㐺ᗘ࡞㌟యάືࡣࠊ Ᏻᐃࡋࡓ +) ᝈ⪅࠾ࡅࡿᶆ‽ⓗ࡞་Ꮫ⒪ἲే⏝ࡋ࡚᥎ዡࡍࡿࡇࡀ࡛ࡁࡿࠋⴭ⪅ࡀ㏙ ࡚࠸ࡿࡼ࠺ࠊࣚ࢞⩌ࡢ᪉ࡀᨵၿ⋡ࡀ㧗ࡗࡓࡢࡣࠊࣚ࢞ࡼࡿධࡀឤ⚄⤒ࢆඃ ࡉࡏࠊࡑࡢ⤖ᯝࠊᚰ➽ࡢ㈇Ⲵࡸࢫࢺࣞࢫࡀ㍍ῶࡉࢀࡓࡶࡢ᥎ ࡉࢀࡿࠋࡋࡋࠊ ᭷ᐖ㇟ࡣሗ࿌ࡉࢀ࡞ࡗࡓࡋ࡚࠸ࡿࡀࣚ࢞⩌࠾࠸࡚ධࡀ୰᩿ࡉࢀࡓ ேࡢ⌮⏤ ࢆ᫂☜ࡍࡿᚲせࡀ࠶ࡿ⪃࠼ࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ᚰᝈ⪅ᑐࡋ࡚ࠊࣚ࢞ࢆ᮲௳ࡁ່࡛ࡵࡿ $EVWUDFWRUDQG'DWH ⚽ ᒸᏕ − 161 − 㸷ᚠ⎔ჾ⣔ࡢᝈ (,&ᚰ ᩥ⊩ Krishna BH, et al. Yoga improves quality of life and functional capacity in heart failure patients.Biomedical Reseach India,2014;25(2) ┠ⓗ ࣚ࢞ࡢධ࡛ᚰᝈ⪅㸦1<+$Ϩ㸤ϩ㸧ࡢ㌟యᶵ⬟ࡸ 42/ ࡀᨵၿࡉࢀᚓࡿ࠺ࢆほᐹ ࡍࡿࡓࡵࠋ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) ཧຍ⪅ ᚰᝈ⪅ ྡ ᖹᆒᖺ㱋㸦ධ⩌sࠊࢥࣥࢺ࣮ࣟࣝ⩌s㸧 ධ ࣚ࢞ࢭࣛࣆ࣮ ศẖ᪥ 㐌㛫㸩 ศ㐌 ᪥㸦 ᪥┘どୗ㸩 ᪥⮬Ꮿ㸧 㐌㛫 $UPධ⩌ࣚ࢞㸩㏻ᖖ⒪⩌ ྡ $UPࢥࣥࢺ࣮ࣟࣝ⩌㏻ᖖ⒪⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 6 ศࡢṌ⾜ヨ㦂㸦6 min walk test, 6MWT㸧 ࠊᚰᝈ⪅ࡢ QOL(Minnesota living with heart failure questionnaire, MLWHFQ)ࢆධ๓ࠊධᚋࡢ 2 ᅇ ᐃࠋ ࡞⤖ᯝ 12㐌㛫ᚋMLWHFW-totalࡣࢥࣥࢺ࣮ࣟࣝ⩌࡛ࡣ9.1㸣ࡢῶᑡ࡛࠶ࡗࡓࡢᑐࡋࣚ࢞⩌࡛ࡣ 45㸣࡛࠶ࡗࡓࠋMLWHFW-physical dimension ࡛ࡣࢥࣥࢺ࣮ࣟࣝ⩌ 3.9%ᑐࡋࣚ࢞⩌࡛ࡣ 46.4㸣ࡢῶᑡࢆㄆࡵࡓࠋMLWHFW-emotional dimension ࡛ࡣࢥࣥࢺ࣮ࣟࣝ⩌࡛ 6.6%ࠊࣚ࢞ ⩌࡛ 65.7%ࡢῶᑡ࡛࠶ࡗࡓࠋࡲࡓ 6MWT ࡛ࡣࢥࣥࢺ࣮ࣟࣝ⩌࡛ 12.4%ࡋᨵၿࡋ࡞ࡗ ࡓࡢᑐࡋࣚ࢞⩌࡛ࡣ 66.2㸣ࡶᨵၿࡋࡓࠋ 㸦ࣚ࢞⩌ࡣࡍ࡚ p<0.001 ࡛᭷ព࡞ᨵၿࠋࢥࣥ ࢺ࣮ࣟࣝ⩌࡛ࡣ p<0.05, ࡶࡋࡃࡣ p<0.01 ࡛᭷ព࡞ᨵၿ㸧 ࠋ ⤖ㄽ 12 㐌㛫ࡢࣚ࢞ࡢᐇࡣࢥࣥࢺ࣮ࣟࣝẚ࡚ᚰᝈ⪅(NYHAϨ㸤ϩ)ࡢ㌟యᶵ⬟ QOL ࢆᨵၿࡉࡏࡿࠋ Ᏻᛶ㛵ࡍࡿゝཬ ࡞ࡋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ධ⩌Q ࢥࣥࢺ࣮ࣟࣝ⩌Q ࣚ࢞ࡢヲ⣽ ᝈ⪅୍ே୍ேࡢ་⒪ヲ⣽ࡸᩚᙧⓗ࡞㝈⏺ྜࢃࡏ࡚ࠊෆᐜࢆಟṇࡋࡓࠋ❧࡚࡞࠸ᝈ⪅ࡣ᳔ Ꮚࢆ⏝ࠋ❧ࡢࣂࣛࣥࢫ࣏࣮ࢬࡢࡣቨࢆᨭ࠼ࡋ࡚⾜ࡗࡓࠋࣉ࣮ࣛࢼ࣮࣮࣐ࣖ྾ ἲ྾ࢆព㆑ࡍࡿ⦎⩦ࡣ῝ࡃ྾ࡗ࡚ࠊ῝ࡃྤࡁฟࡍ྾ࢆṆᜥࡍࡿ࡞ࡃ㸯㸸㸯ࡢྜ ࡛⾜ࡗࡓࠋᜥࢆ྾࠺ࡁࡣ⭡㒊ࡽጞࡲࡾࠊ⬚ࠊ⬚ࡢୖ㒊㐃⥆ࡋ࡚ࢃࡁ㉳ࡇࡿ྾ࢆ ព㆑ࡋࠊྤࡃࡁࡣ㏫ࡢ㡰࡛⾜ࡗࡓࠋ▂ࣜࣛࢡࢭ࣮ࢩࣙࣥࡣ௮ྥࡅᗙ࡛ࠊᝈ⪅ࡀ ᛌ㐺࡞ጼໃࢆ⮬ࡽ㑅ࢇ࡛ࡶࡽࡗࡓࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ᮏ◊✲࡛ࡣ୧⩌ࡶࠊධᮇ㛫ᚋࠊ࠸ࡎࢀࡢ࢘ࢺ࣒࢝㡯┠ࡶᨵၿࡋ࡚࠸ࡿࠋධᚋࡢ ⩌㛫ẚ㍑ࡀ♧ࡉࢀ࡚࠸࡞࠸ࡢ࡛ࠊࡕࡽࡀࡼࡾඃࢀ࡚࠸ࡿࡢุ᩿ࡣ࡛ࡁ࡞࠸ࠋࣚ࢞ࡢᐇ ࡼࡾᚰᝈ⪅ࡢᶵ⬟ࡸ 42/ ࡀྥୖࡍࡿࡇࡀ♧၀ࡉࢀࡿࠋᚋࡣࣚ࢞ࡀලయⓗ ࡢࡼ࠺㌟యᶵ⬟ࢆᨵၿࡍࡿࡢࠊࡲࡓࡢࡼ࠺࡞ࣚ࢞ࡢᐇࡀࡶࡗࡶ᭷ຠࠊࡉࡽ࡞ ࡿ◊✲ࡀᚅࡓࢀࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ㍍ᗘᚰᝈ⪅1<+$Ϩ㸤ϩ࠾࠸࡚ࣚ࢞ࢆ່ࡵࡿࠋ 㸦ࣚ࢞ࢆᐇࡍࡿࡇ࡛᭷ព 42/ ࡸ㌟యᶵ⬟ᨵၿࡀㄆࡵࡽࢀࡿࡢ࡛㸧 $EVWUDFWRUDQG'DWH ᒸభ ᒸᏕ − 162 − 㸷ᚠ⎔ჾ⣔ࡢᝈ ,ᚰ ᩥ⊩ Pullen PR, et al. Benefits of Yoga for African American Heart Failure Patients. Med Sci Sports Exerc. 2010 Apr; 42(4): 651-7. Pubmed ID19952833 ┠ⓗ ་ᏛⓗᏳᐃࡋࡓᚰᝈ⪅ࡢᚰ⾑⟶⣔⪏ஂຊࠊ4ROࠊ⅖࣐࣮࣮࢝ᑐࡍࡿࣚ࢞ࡢຠᯝ ࢆ᳨ウࡍࡿ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ ࢪ࣮ࣙࢪᕞࢺࣛࣥࢱࡢࢢࣛࢹ࣮࣊ࣝࢫࢣࢩࢫࢸ࣒ࡢ࣓ࣥ㝔࠶ࡿᚰ⮚◊✲ ᡤ ཧຍ⪅ ᚰࡢࣇࣜ࢝⣔࣓ࣜ࢝ே ྡ ṓ ධ ࣚ࢞ࣛࣥࢫ ᅇ ศ㐌 ᅇ 㐌㛫⮬Ꮿᐇ⩦ࢆ㐌 ᅇ່ࡵࡓ $UPධ⩌ࣚ࢞⩌ ྡ࡞ $UPࢥࣥࢺ࣮ࣟࣝ⩌ᚅᶵ⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ ࢺࣞࢵࢻ࣑ࣝ㐠ື㈇Ⲵヨ㦂(VO2peakࠊsit and reach test(⬚ࡢᰂ㌾ᛶ)ࠊᰂ㌾ᛶࠊthe Minnesota Living with Heart Failer Questionnaire(ᚰᝈ⪅ࡢ QoL)ࠊ⾑୰ࣂ࣐࣮࣮࢜࢝㸸 IL-6,high-sensitivity C-reactive protein (hs-CRP),extracellular superoxide dismutase (EC-SOD)ࢆ ධ๓ࠊධᚋࡢ㸰ᅇ ᐃࠋ ࡞⤖ᯝ 㐠ື⬟㸸ධ๓ᚋ࡛ࠊࣚ࢞⩌ࡣࢺࣞࢵࢻ࣑ࣝ㛫ࠊVO2peak ࡶᨵၿࡋࡓࡢᑐࡋ࡚ࠊ ࢥࣥࢺ࣮ࣟࣝ⩌ࡣࡸࡸపୗࡋࡓࠋධᚋࡢ್ࡣࣚ࢞⩌ࡢ᪉ࡀ᭷ពⰋࡗࡓࠋ ᰂ㌾ᛶ㸸ධ๓ᚋ࡛ẚ㍑ࡋ࡚ࠊࣚ࢞⩌ࡣ᭷ពᨵၿࡋࡓ(P=0.002)ࠋ QOL:ධ๓ᚋ࡛ẚ㍑ࡋ࡚ࣚ࢞⩌ࡣࢺ࣮ࢱࣝࢫࢥ㌟యⓗࢧࣈࢫࢣ࣮ࣝࡀ᭷ពᨵၿࡋ ࡓࠋࢥࣥࢺ࣮ࣟࣝ⩌᭷ពᕪࡣ࡞ࡗࡓࠋ ⾑୰࣐࣮ ࣮࢝㸸ࣚ࢞ ⩌࡛ࡣධᚋ IL-6(P<0.001) ࠊhs-CRP(P<0.001) ࡣపୗࡋࠊ EC-SOD(P<0.001)ࡣቑຍࡋࡓࠋධᚋࡢ⩌㛫ẚ㍑࡛ࡶࠊࡇࢀࡽࡢ್ࡣࢥࣥࢺ࣮ࣟࣝ⩌ࡢ 㛫᭷ពᕪࡀ࠶ࡗࡓࠋ ⤖ㄽ ᶆ‽ⓗ࡞་⒪ࢆཷࡅ࡚࠸ࡿᚰᝈ⪅ࡀࣚ࢞ࢆ⾜࠺ࡇࡣࠊ㐠ື⬟ຊࠊQoL, ⾑୰⅖࣐ ࣮࣮࢝ࠊᢠ㓟㓝⣲ࠊᰂ㌾ᛶࡀᨵၿࡋࠊ┦ຍⓗ᭷⏝ᛶࡀ࠶ࡿࠋ Ᏻᛶ㛵ࡍࡿゝཬ ࡞ࡋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ධ⩌ ྡࠊࢥࣥࢺ࣮ࣟࣝ⩌ ྡ ⌮⏤ࡣ᫂ ࣚ࢞ࡢヲ⣽ ఏ⤫ⓗ࡞ࣁࢱࣚ࢞ࡢ࣏࣮ࢬࢆ ศࠋ๓ᒅࡸᚋᒅࡢ⤌ࡳྜࢃࡏࢶࢫࢺࡸࣂࣛࣥࢫ࣏࣮ࢬ ࡞ࡶྵࢇ࡛࠸ࡿࠋ⡆᫆㸭ᨵⰋࣂ࣮ࢪࣙࣥ㸦ࣔࢹࣇࢣ࣮ࢩࣙࣥ㸧ࡣᝈ⪅ಶࠎேࡢ་Ꮫ ⓗࠊᩚᙧእ⛉ⓗไ㝈ࢆ⪃៖ࡋྛேࡢ࣮࣌ࢫ࠶ࢃࡏ࡚సࡽࢀࡓࠋࣇ࣮ࣟࡽ❧ࡕୖࡀࡿ ࡇࡀ࡛ࡁ࡞࠸ᝈ⪅᳔Ꮚࡀ⏝ࡉࢀࡓࠋᚲせᛂࡌ࡚ቨ࡞ࡀࣂࣛࣥࢫ࣏࣮ࢬࡢ ⏝ࡉࢀࡓࠋࡑࢀࡒࢀࡢࢭࢵࢩ࡛ࣙࣥᐇࡉࢀࡓㄢ㢟ࡣ௨ୗࡢ㏻ࡾࠋࣈ࣮ࣜࢪࣥࢢ࢚ࢡࢧࢧ ࢬࣉ࣮ࣛࢼ࣮࣮࣐ࣖࢆྵࡴ ศ㛫ࡢ࢛࣮࣑࢘ࣥࢢࢵࣉࢆ⾜࠺ࠋ▂ࣜࣛࢡࢭ࣮ࢩ ࣙࣥࡣᐇ⩦⪅ࡢᚰᆅࡼࡉᛂࡌ࡚௮ྥࡅᗙ࡛⾜ࢃࢀࡓࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ $EVWUDFWRU ࡢ᥎ዡᗘ ་ᏛⓗᏳᐃࡋࡓᚰᝈ⪅ᑐࡋ࡚་Ꮫⓗ⒪ຍࡍࡿᙧ࡛ࣚ࢞ࢆ່ࡵࡿࠋ $EVWUDFWRUDQG'DWH ྜྷఫ῟Ꮚ ᒸᏕ − 163 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ᚰ㸧 ᩥ⊩ Pullen PR et al. Effects of Yoga on Inflammation and Exercise Capacity in Patients With Chronic Heart Failure. Journal of Cardiac Failure 2008; 14: 407-413. Pubmed ID:18514933 ┠ⓗ ᶆ‽ⓗ࡞⸆≀⒪ἲຍ࠼࡚ 8 㐌㛫ࡢࣚ࢞⒪ἲࡣࠊᚰᝈ⪅ࡢ㐠ື⬟ຊ࣭⅖ᛂ࣭⏕ά ࡢ㉁ࢆᨵၿࡍࡿㄪᰝࡍࡿ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ ࢚࣮ࣔࣜᏛ㸦ࢪ࣮ࣙࢪᕞࢺࣛࣥࢱ㸧 ཧຍ⪅ 1<+$ ࢡࣛࢫ ,,,, ࡢᝈ⪅ᖹᆒᖺ㱋 ṓࡢ⏨ዪ ྡ ධ ࣚ࢞ࣛࣥࢫ ᅇ ศ㐌 ᅇ 㐌㛫ィ ᅇ $UPධ⩌ ⸆≀⒪ἲ㸩ࣚ࢞ ྡྠ࣓ࢽ࣮ࣗࢆ⮬Ꮿ࡛ࡶᐇ⩦㐌 ᅇ $UPࢥࣥࢺ࣮ࣟࣝ⩌ ⸆≀⒪ἲ⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 㐠ືヨ㦂࠾࠸࡚1.VO2max(᭱㓟⣲ᦤྲྀ㔞) 2. ྍ⁐IL-6, hsCRP(㧗ឤᗘCRP), EC-SOD㸦άᛶ㓟⣲ศゎ㓝⣲㸧ࠊ3.MLHFQ(࣑ࢿࢯࢱᚰQOL㉁ၥ⾲)ࢆ ධ๓ᚋ࡛ ᐃࠋ ࡞⤖ᯝ ࢺࣞࢵࢻ࣑ࣝ㛫ࡣᐇ⩦๓ᚋ࡛᭷ពᕪࡀ࠶ࡗࡓ(P=0.03) ࠋࣚ࢞⩌࡛18%ቑຍࡋࡓ㸦᭷ព࡞ ቑຍࠊp=0.02㸧ࡀࢥࣥࢺ࣮ࣟࣝ⩌࡛ࡣ7.5%ῶᑡࡋࡓ㸦᭷ព࡞ኚ࡛ࡣ࡞࠸㸧 ࠋ᭱㓟⣲ᾘ ㈝㔞ࡶࣚ࢞ධ๓ᚋ࡛᭷ពኚࡋࡓ(P=0.018)ࠋࣚ࢞⩌࡛ࡣ17%ቑຍࡋࡓ㸦᭷ព࡞ቑຍࠊ p=0.024㸧ࡀࢥࣥࢺ࣮ࣟࣝ⩌࡛ࡣ7.1%ῶᑡࡋࡓ㸦᭷ព࡞ኚ࡛ࡣ࡞࠸㸧 ࠋ ⅖࣐࣮࣮࢝㸸⩌ෆẚ㍑㸸ࣚ࢞⩌࡛ࡣᐇ⩦๓ᚋ࡛IL-6(P<0.001)CRP(P=0.002) ࡣ᭷ព పୗࡋࠊEC-SODࡣ᭷ពቑຍࡋࡓ(P=0.002)ࠋࡉࡽ⩌㛫ẚ㍑࡛ࡣࠊධᚋࡢࡇࢀࡽࡢ್ ࡣ୧⩌㛫࡛᭷ពᕪࡀ࠶ࡗࡓࠋ(IL-6<0 .001, CRP; P=0 .002, EC-SOD; P<0.001)ࠋ⏕άࡢ㉁࡛ࡣ ୧⩌࡛᭷ពᕪࡣ࡞ࡗࡓࠋ ⤖ㄽ ࣚ࢞ࡣᚰᝈ⪅ࡢ㐠ື⪏ᐜ⬟ࢆᨵၿࡋࠊ⅖࣐࣮࣮࢝ࢆపୗࡉࡏࡓࠋ Ᏻᛶ㛵ࡍࡿゝཬ ᅇࣚ࢞⒪ἲ⩌ࡢᝈ⪅࠾࠸࡚ࠊస⏝ࡣ࡞ࡗࡓࠋ⯆῝࠸ࡇࠊ୧⩌ࡶᐇ⩦ཧຍ ⋡ࡣ 100%࡛࠶ࡗࡓࠋດຊࡀᚲせ࡞ᚑ᮶ᆺࡢ᭷㓟⣲㐠ືẚ㍑ࡋ࡚ࠊ㌟య㞀☀⪅ࡸ㧗㱋⪅ ࡸ㛵⠇⅖ࡸᚰ࡞ࡢ៏ᛶࡢ⾶ᙅࡋ࡚࠸ࡿᝈᝈ⪅࠾࠸࡚ࠊಟṇࡉࢀࡓࣚ࢞ࡢయࡣ Ᏻᐇ⩦࡛ࡁࡿࠋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ୧⩌ඹ㸮㸣 ㏣㊧⋡ࡣ 㸣࡛࠶ࡗࡓ ࣚ࢞ࡢヲ⣽ 10ศࡢ‽ഛ㐠ືࠊ40ศࡢ❧ࡲࡓࡣᗙࡢࣚ࢞ࡢ࣏࣮ࢬ㸦࣮ࢧࢼ㸧ࠊ20ศࡢ྾ἲ㸦ࣉ ࣮ࣛࢼ࣮࣮࣐ࣖ㸧ࠊࡑࡋ࡚▂ࢆ⾜ࡗࡓࠋࣚ࢞ᐇ⩦ࡢ๓ᚋ࡛ᚰᢿᩘ⾑ᅽࢆ ᐃࡋࡓࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ Yoga therapymedical therapyࡢ㛫᭷ពᕪࡀฟࡓࡀࠊᩘࡀᑡ࡞࠸ࡢ࡛ಙ㢗ᛶࡀ༑ ศ࡛ࡣ࡞࠸ࠋᚋࡣᩘ࣭ᮇ㛫ࢆቑࡸࡋࠊᶆ‽ⓗ࡞㐠ືࡸᚰ⮚ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࣉࣟ ࢢ࣒ࣛࡢẚ㍑᳨ウࢆ⾜࠺ᚲせࡀ࠶ࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ᚰᝈ⪅ᑐࡋ࡚ᢞ⸆ຍ࠼࡚ࣚ࢞⒪ἲࢆᐇ⩦ࡍࡿࡇࢆ᮲௳ࡁ່࡛ࡵࡿ $EVWUDFWRUDQG'DWH ⃝ᒸᆒ ᒸᏕ − 164 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ᚰᝈ㸧 ᩥ⊩ Toise SC, et al: Psychosocial and Cardiac Outcomes of Yoga for ICD Patients: A Randomized Clinical Control Trial. Packing Clin Electrophysiol.2014;37(1):48-62. PubMed ID:23981048 ┠ⓗ ᇙࡵ㎸ࡳᘧ㝖⣽ືჾࢆᇙࡵ㎸ࢇࡔᝈ⪅ᑐࡍࡿࣚ࢞ࡢᚰ⌮ⓗຠᯝࠊᚰ⮚ࡢᙳ㡪ࢆ᳨ウࡍ ࡿࠋ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂5&7 ࢭࢵࢸࣥࢢ ࢚࣮ࣝᏛ㝔ࠊࢥࢿࢳ࢝ࢵࢺᕞࠊࢽ࣮ࣗ࣊ࣈࣥࠊ࣮ࢫࢺ࢝ࣟࣛࢼᏛࠊᚰ⌮Ꮫ㒊 ᚰ⾑⟶⛉Ꮫ㒊 ࣀ࣮ࢫ࢝ࣟࣛࢼᕞࠊࢢ࣮ࣜࣥࣅࣝࠊ࢚࣮ࣝ⸆⛉Ꮫࠊࢥࢿࢳ࢝ࢵࢺ ᕞࠊࢽ࣮ࣗ࣊ࣈࣥࠊࣂࢼ࣮ᗣᚰ⾑⟶ࣀ࣮ࢫ࣭ࢥࣟࣛࢻᏛࠊࢥࣟࣛࢻᕞࠊࢢ࣮࣮ࣜࣜࠊ ࢚࣮ࣝᏛ⫋ᴗࠊ⎔ቃ་Ꮫࠊෆ⛉㒊ࠊ࢚࣮ࣝᏛࠊࢥࢿࢳ࢝ࢵࢺᕞࠊࢽ࣮ࣗ࣊ࣈࣥ ཧຍ⪅ ཧຍ⪅ࡣ,&'ཷ⌮⪅ࠋṓ௨ୖ࡛ࠊධࡢ᭱ప㐌㛫๓⨨ࢆཷࡅྲྀࡗࡓྡ ධ $UPࣚ࢞⩌ ྡ ศ㐌 ᅇ 㐌㛫⮬Ꮿᐇ⩦ &' ࢆΏࡉࢀ ศ㐌 ᅇ $UPᑐ↷⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 1. FSAS(ࣇࣟࣜࢲࢩࣙࢡᏳẚ⋡) 2.FPAS(ࣇࣟࣜࢲᝈ⪅ࡢᢎㅙㄪᰝ ) 3.CES-D(࠺ࡘ) 4.PHE(⫯ᐃⓗᗣ) 5.STPI(ᕞ≉ᚩ≉ูே᱁┠㘓) 6.IPS(ᑐேࢧ࣏࣮ࢺホ౯) 7.SCS(ࢭࣝࣇ ࢥࣥࣃࢵࢩࣙࣥࠊ⮬ឿᚰ) 8.SEC(ᚩೃ࣭ឤࢳ࢙ࢵࢡࣜࢫࢺ) 9.EMT(⾲⌧᧯సࢸࢫࢺ)ࠊ ධ๓ࠊධᚋ࡛ẚ㍑ࠋ ࡞⤖ᯝ ࣚ࢞⒪ἲ⩌ࡢࢩࣙࢵࢡᏳࡣ᭷ពῶᑡࡋࠊᑐ↷⩌ࡢࢩࣙࢵࢡᏳࡣ᭷ពቑ࠼ࡓࠋ ࡲࡓࣚ࢞⒪ἲ⩌ࡣࠊࢥࣥࢺ࣮ࣟࣝ⩌ẚࠊࢭࣝࣇࢥࣥࣃࢵࢩࣙࣥࠊ࣐ࣥࢻࣇࣝࢿࢫࡢ ᚓⅬࡀ㧗ࡃ࡞ࡗࡓࠋ ࡉࡽࠊࣚ࢞⒪ἲ⩌ࡢ᪉ࡀࠊࢥࣥࢺ࣮ࣟࣝ⩌ࡼࡾdevise-treated ventricular (DTV) event 㸦ᚰ ᐊ࣋ࣥࢺ㸧ࡢ㢖ᗘࡀ᭷ពపࡗࡓ(P < 0.0001)ࠋ ⤖ㄽ ࣚ࢞ࡣᇙࡵ㎸ࡳᘧ㝖⣽ືჾࢆᇙࡵ㎸ࢇࡔᝈ⪅ᑐࡋ࡚ࠊᚰ⌮♫ⓗ┈ࡀ࠶ࡿࠋ Ᏻᛶ㛵ࡍࡿゝཬ ≉ゝཬࡉࢀ࡚࠸࡞࠸ࠋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ࣚ࢞⩌㸸 ྡ ᑐ↷⩌㸸 ྡ ࣚ࢞ࡢヲ⣽ ICD ᚰ⮚ᝈ⪅⏝ࣚ࢞ࣉࣟࢢ࣒ࣛ㸸Toise, Ph.D, M.P.H., unpublished NIH grant, 2007 $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ICDᝈ⪅ࡀឤࡌ࡚࠸ࡿ㟁ẼࢩࣙࢵࢡᑐࡍࡿᏳࡀࠊࣚ࢞⒪ἲࡼࡾῶᑡࡉࢀࡓ࠸࠺Ⅼ ࡣ࡚ࡶព⩏ࡀ࠶ࡿᛮ࠺ࠋ ࣚ࢞ࡼࡗ࡚ᚰᐊ࣋ࣥࢺࡀపࡃ࡞ࡿⅬࡣ≉➹ࡍࡁ࡛࠶ࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ICDᝈ⪅ᑐࡋ࡚ࣚ࢞⒪ἲࢆ່ࡵࡿࠋ $EVWUDFWRUDQG'DWH ᐑᓮ┿ᘪ ᒸᏕ − 165 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ᚰᝈ㸧 ᩥ⊩ Innes KE, et al: A New Educational Film Control for Use in Studies of Active Mind-Body Therapies: Acceptability and Feasibility. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE 2011; Volume 17, Number 5, 453-458.PubMed ID:21554109 ┠ⓗ ᚰ⾑⟶ᝈࣜࢫࢡࡢ࠶ࡿ㛢⤒ᚋࠊ⫧‶࡛࠶ࡲࡾ㐠ືࢆࡋ࡞࠸ዪᛶࡢᚰ㌟⒪ἲࡋ࡚ࣚ࢞ ࡢຠᯝࢆ᳨ドࡍࡿࠋ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ ࣓ࣜ࢝ࡢタ㸦་⒪タࣚ࢞ᩍᐊࡣ᫂㸧 ཧຍ⪅ ᚰ⾑⟶ᝈࣜࢫࢡࡢ࠶ࡿ࠶ࡲࡾ㐠ືࡋ࡞࠸㛢⤒ᚋࡢ⫧‶ዪᛶ ṓ ྡ ධ $UPධ⩌ࣚ࢞⩌ ྡ ᅇ ศ㐌 ᅇ 㐌㛫 '9' ᯛࣈࢵࢡࣞࢵࢺࡀ㓄ᕸࡉࢀࠊࢡࣛࢫࡢ࡞࠸᪥ ศ⮬Ꮿᐇ⩦ࢆᣦᑟ $UPᑐ↷⩌ᩍ⫱ᫎ⏬ど⫈⩌ ྡ ᅇ ศ㐌 ᅇ 㐌㛫 ୧⩌ࡶ ࢡࣛࢫࡢࢧࢬࡣ ྡ௨ୗࠋᑐ↷⩌ࡣࣚ࢞ࢡࣛࢫࡢ↓ᩱๆࡀᨭ⤥ࡉࢀࠊ ࣚ࢞⩌ࡶ᭱⤊ホ౯⤊ᚋᫎ⏬ど⫈ࡢᶵᥦ౪ࡀ࠶ࡗࡓ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ ࣥࢫࣜࣥᢠᛶࡸ⏕⌮ⓗ࣭ேయ ᐃⓗࣜࢫࢡᅉᏊࡢᣦᶆ࣭⒪ຠᯝࡢᮇᚅᗘ࣭ฟཱྀㄪ ᰝࠊධ๓ࠊ8 㐌ᚋẚ㍑ࠋ ࡞⤖ᯝ ⤖ᯝࡣグࡉࢀ࡚࠸࡞࠸㸦୧⩌㛫࡛ࠊ⒪ຠᯝࡢᮇᚅᗘ⤫ィⓗ᭷ព࡞ᕪࡣぢࡽࢀ࡞ࡗ ࡓࠋ୧⩌ࡢཧຍ⪅ࠊࡑࢀࡒࢀࡾᙜ࡚ࡽࢀ࡞ࡗࡓࣉࣟࢢ࣒ࣛࡢࢡࢭࢫࢆᥦ౪ࡋࡓ ࡇࡣࠊࣛࣥࢲ࣒ẚ㍑ヨ㦂ࡢཧຍ⪅ເ㞟ࡸࠊཧຍ⪅ࡀࣉࣟࢢ࣒ࣛࢆ⥆ࡅࡿࡇࡶᙺ❧ࡗ ࡓࡶࡋࢀ࡞࠸ࠋᫎ⏬ど⫈ࢡࣛࢫࡢཧຍ⪅ࡢ㸯ேࡣࠊᙜึࣚ࢞⩌ࡾศࡅࡽࢀ࡞ࡗࡓ ࡇⴠ⫹ࡋࡓࡀࠊᫎ⏬࡛ሗゐࢀࡿࡇࡀ࡛ࡁࣚ࢞ࢡࣛࢫࡶ↓ᩱๆ࡛ཧຍࡍࡿࡇ ࡀ࡛ࡁࡿࡢࡣᖾ㐠ࡔࡗࡓ⪃࠼ࢆኚ࠼ࠊࡇࢀྠㄪࡍࡿ⪅ࡶከࡗࡓࠋࣚ࢞⩌ࡢཧຍ⪅ࡢ ከࡃࡶᫎ⏬⯆ࢆ♧ࡋࡓࠋᫎ⏬ࢡࣛࢫ࡛ࡣど⫈ᚋࡢὶࡢ㛫࡞ࡢ♫ⓗᅉᏊࢆዲࡲ ࡋ࠸ࡋࡓཧຍ⪅ࡀከ࠸୍᪉ࠊ㸯ேࢆ㝖ࡃဨࡀࣉࣟࢢ࣒ࣛࡢᫎ⏬ෆᐜゝཬࡋ࡚࠸ࡿࡇ ࡽࠊ◊✲ᑐ㇟⪅ྜࢃࡏࡓᫎ⏬ࡢ㑅ᢥࡀ㠀ᖖ㔜せࡔぢࡽࢀࡿࠋ 㸧 ⤖ㄽ 㛢⤒ᚋዪᛶࡢᚰ⾑⟶ᝈࡢࣜࢫࢡᑐࡋ࡚ࡢࣚ࢞ࡢຠᯝ㛵ࡍࡿࣛࣥࢲ࣒ẚ㍑ヨ㦂ࡢㄪ ᰝ⤖ᯝࡣࠊࡇࡢᩍ⫱ᫎ⏬ࢡࣛࢫࡢᑐ↷⩌ࡣᐇ⌧ྍ⬟࡛࠶ࡾࠊཧຍ⪅ࡶཷࡅධࢀࡽࢀࡓࠊ ♧၀ࡍࡿࠋ 㸦ᢒヂ⪅ὀ㸸ࣚ࢞ࡢ᥎ዡᗘ㛵ࡍࡿゝཬࡣࡇࡢㄽᩥෆ࡛ࡣࡳࡽࢀ࡞࠸㸧 Ᏻᛶ㛵ࡍࡿゝཬ ࡞ࡋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ࣚ࢞⩌㸣 ᫎ⏬ど⫈⩌㸦㸣㸧 ࣚ࢞ࡢヲ⣽ ࡇࡢࢢ࣮ࣝࣉࡢࡓࡵ≉ูࢹࢨࣥࡉࢀࡓ gentle beginner Iyengar yoga $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ᮏㄽᩥࡣࣚ࢞ධࡢຠᯝࡘ࠸࡚ࡢ㆟ㄽ࡛ࡣ࡞ࡃࠊᑐ↷⩌ࡢෆᐜᩍ⫱ⓗᫎ⏬ࡢど⫈ࡢጇ ᙜᛶࡘ࠸࡚࡛࠶ࡗࡓࠋࣚ࢞ධࡢࣛࣥࢲ࣒ẚ㍑ヨ㦂࡛ᑐ↷⩌ᫎ⏬ࡢど⫈ࢆ᥇⏝ࡍࡿ ࠸࠺ࡢࡣ⯆῝࠸ࠋཧຍ⪅ࡢ‶㊊ᗘࡶ㧗࠸ࡼ࠺࡛࠶ࡿࠋࡋࡋࠊࡇࢀࡣ 㐌㛫ࡢࣉࣟࢢࣛ ࣒࡛࠶ࡾࠊࡶࡗ㛗ᮇ㛫ཬࡪ◊✲ࡣྥ࡞࠸⪃࠼ࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ 㸦ヱᙜࡋ࡞࠸㸧 $EVWUDFWRUDQG'DWH ▼ᮧ༓᫂ ᒸᏕ − 166 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,ᚰᝈ㸧 ᩥ⊩ Robert-McComb JJ, et al. A Pilot Study to Examine the Effects of a Mindfulness-Based Stress-Reduction and Relaxation Program on Levels of Stress Hormones, Physical Functioning, and Submaximal Exercise Responses, THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE,10(5), 2004: 819–827. Pubmed ID:15650471 ┠ⓗ ᚰ⮚ࢆࡶࡘ፬ேࡢᏳ㟼ࡢࢫࢺࣞࢫ࣍ࣝࣔࣥࠊ㌟యⓗᶵ⬟ࠊ᭱ୗ㐠ື࠾࠸࡚ 8 㐌㛫 ࡢ MBSR ࡢຠᯝࢆㄪࡿࡇࠋ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ Texas Tech University, Lubbock, TXࡢ タ ཧຍ⪅ ᚰ⮚ᑓ㛛་ࡼࡗ࡚ᢎㄆࡉࢀࡓࠊᚰ⾑⟶ࡢዪᛶ ྡᖹᆒᖺ㱋 ṓ ධ 0%65 ᅇ ศ㐌 ᅇኪ 㐌㛫 $UPධ⩌ࣚ࢞⩌ ྡ $UPࢥࣥࢺ࣮ࣟࣝ⩌ᚅᶵ⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 㸯㸧Ᏻ㟼࢝ࢸࢥ್࣮࣑ࣝࣥࠊࢥࣟࢳࢰ್࣮ࣝࠊ 㸰㸧SF-36 ㌟యࢥ࣏࣮ࣥࢿࣥࢺࢫࢥ㸦㌟యᶵ⬟㸧 㸱㸧⮬㌿㌴ࡇࡂࢆ 24 ศ⾜࡞࠸ࠊ᭱ᚋࡢ㸳ศࡢ㓟⣲ᾘ㈝㔞ࠊ྾ᩘࠊ1 ᅇẼ㔞ࠊᚰᢿᩘࠋ ࡞⤖ᯝ Ᏻ㟼ࡢࢫࢺࣞࢫ࣍ࣝࣔࣥ㸦࢝ࢸࢥ࣮࣑ࣝࣥࠊࢥࣝࢳࢰ࣮ࣝ㸧ࡢ್ࡸ㌟యᶵ⬟ࡣ᭷ព ࡞ຠᯝࡸ┦స⏝ࡣ࡞ࡗࡓࠋ᭱㐠ືୗᛂ㸦㓟⣲ᾘ㈝㔞ࠊᚰᢿᩘࠊ྾ᩘࠊẼࠊ1 ᅇẼ㔞㸧ࡶ୧⩌࡛᭷ព࡞┦స⏝ࡣ࡞ࡗࡓࠋࡓࡔࡋࠊࢥࣥࢺ࣮ࣟࣝ⩌ࡼࡾ MBSR ⩌ ࡢ᪉ࡀࠊ྾ᩘࡀపࡃࠊ1 ᅇẼ㔞ࡀከࡗࡓࠋ ⤖ㄽ ᚰ⮚ࢆࡶࡗࡓ፬ேࡢ 8 㐌㛫ࡢࢫࢺࣞࢫ㝖ཤࣉࣟࢢ࣒ࣛࡣᏳ㟼ࢫࢺࣞࢫ್࣍ࣝࣔࣥࠊ㌟ యⓗᶵ⬟ࠊ᭱ୗ㐠ືᛂ࠾࠸࡚ࡶ⩌㛫࡛᭷ព࡞┦స⏝ࡣࡳࡽࢀ࡞ࡗࡓࠋ Ᏻᛶ㛵ࡍࡿゝཬ ࡞ࡋ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ྡ ࣚ࢞ࡢヲ⣽ MBSRࣉࣟࢢ࣒ࣛ㸸ࣁࢱࣚ࢞ࡢ⦎⩦ࡣ྾ἲࡢカ⦎ࠊ༢⣧࡞ࢫࢺࣞࢵࢳࠊ➽㦵᱁⣔ࢆᙉࡃ ࡋࠊࡃࡘࢁࡄࡓࡵ⪃ࡉࢀࡓ࣏࣮ࢬࢆ⾜࠺ࠋయࡢࢫ࡛࢟ࣕࣥࡣ㊊ࡽ㢌ࡲ࡛ࠊ㌟ࡢ▱ ぬࡸឤぬࠊ࠶ࡿ࠸ࡣ྾ࢆព㆑ࡍࡿࠋ▂ࡣࠊ྾ࡢほᐹᚰࢆほᐹࡋุ᩿ࡋ࡞࠸⦎⩦ࢆ ⾜ࡗࡓࠋ $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ࢧࣥࣉࣝࢧࢬࡀྛ⩌ 9 ேࡎࡘᑡ࡞ࡗࡓࡓࡵࠊせホ౯㡯┠࡛᭷ពᕪࡀฟ࡞ࡗ ࡓࠋNegative data ࡛࠶ࡗࡓࡀࠊ➹⪅ࡽࡣࡇࡢ◊✲ࡣ pilot study ࡛࠶ࡿᙇࡋࠊᑗ᮶ࡢ◊ ✲ࡢ power ࡢィ⟬⏝࡛ࡁࡿ᭩࠸࡚࠸ࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ᚰ⮚ࢆࡶࡘ፬ேࡢᏳ㟼ࡢࢫࢺࣞࢫ࣍ࣝࣔࣥࠊ㌟యⓗᶵ⬟ࠊ᭱ୗ㐠ື࠾࠸࡚ࠊ ࣚ࢞ࡀຠᯝⓗ࠺ࡕࡽࡶゝ࠼࡞࠸ࠋ $EVWUDFWRUDQG'DWH ⃝ᒸᆒ ᒸᏕ − 167 − 㸷ᚠ⎔ჾ⣔ࡢᝈ 㸦,៏ᛶᮇ⬻༞୰ᚋ∦㯞⑷㸧 ᩥ⊩ Maarten A, et al. Randomized Controlled Trial of Yoga for Chronic Poststroke Hemiparesis: Motor Function, Mental Health, and Quality of Life Ouctomes.Top Stroke Rehabil,2014; 21;(3): 256-271. Pubmed ID:24985343 ┠ⓗ ៏ᛶᮇ⬻༞୰ᚋ∦㯞⑷ᑐࡍࡿࣚ࢞ࡢຠᯝࢆࠊㄢ㢟ᣦྥࡢᶵ⬟ࠊࣂࣛࣥࢫࠊྍືᛶࠊ࠺ࡘࠊ Ᏻࠊ42/ 㛵ࡍࡿᡂᯝࡘ࠸࡚ホ౯ࢆ⾜࠺ ◊✲ࢹࢨࣥ ࣛࣥࢲ࣒ẚ㍑ヨ㦂㸦5&7㸧 ࢭࢵࢸࣥࢢ ༡࣮࢜ࢫࢺࣛࣜࠊࢹ࣮ࣞࢻࡢ㒔ᕷ㒊 ཧຍ⪅ ࣨ᭶௨ୖ๓⬻༞୰࡛∦㯞⑷ࡢデ᩿ࢆཷࡅ࡚ࠊࣜࣁࣅࣜࡀࡋ࡚࠸ࡿᝈ⪅ ṓ௨ୖ ධ ࣚ࢞⒪ἲ ᅇ ศ㐌 ᅇ 㐌㛫㸦ࣞࢵࢫࣥ᪥௨እࡣẖ᪥ ศࡢ⮬Ꮿᐇ⩦ࢆ⾜ࡗࡓ㸧 $UPධ⩌ ࣚ࢞⩌ ྡ $UPࢥࣥࢺ࣮ࣟࣝ⩌ ᚅᶵ⩌ ྡ ࡞࢘ࢺ࣒࢝ホ౯ᣦᩘ 㐠ືᶵ⬟ࡣ 1. 9-Hole Peg Test 9(ᡭඛࡢჾ⏝ࡉ) 2. The Motor Assessment Scale(MAS)㐠ືホ ౯ᑻᗘ 3.BBS(⬻༞୰࠾ࡅࡿࣂࣛࣥࢫ) 4. The Two-Minute Walk Distance(2 ศ㛫࡛Ṍࡅ ࡿ㊥㞳) 5. The Comfortable Gait Speed(ᛌ㐺࡞Ṍ⾜ᗘࢸࢫࢺ)ࠋᏳࡸᢚ࠺ࡘࡣ.6. Geriatric Depression Scale-Short Form(ᢚ࠺ࡘ≧ែホ౯) 7. STAI-YI(≧ែᏳ) 9. STAI-Y2(≉ᛶ Ᏻ) 10. Stroke Impact Scale(ᙉᗘࠊᡭࡢᶵ⬟ࠊ⛣ືᗘࠊ᪥ᖖ⏕άࠊឤࠊグ᠈ࠊࢥ࣑ࣗࢽࢣ ࣮ࢩࣙࣥࠊ♫ཧຍࡢάືࠊ࠾ࡼࡧ⬻༞୰ࡢᅇ) ࢆ ධ๓ࠊධᚋࡢ 2 ᅇ ᐃࠋ ࡞⤖ᯝ 㐠ືᶵ⬟࠾࠸࡚ 9HPT ᡂᯝࡢศᯒࡣฟ᮶࡞ࡗࡓࠋMASࠊBBSࠊ2MWDࠊCGS ࡛ࡣ୧ ⩌࡛᭷ពᕪࡣぢࡽࢀ࡞ࡗࡓࠋᏳࡸᢚ࠺ࡘ㛵ࡋ࡚ࠊGDS15ࠊSTAI-Y1 ࠾࠸࡚᭷ពᕪ ࡣ࡞ࡗࡓࡀࠊSTAI-Y2(≉ᛶᏳ)ࡢᣢ⥆㛫㛵ࡋ࡚ࣚ࢞⩌(P=0.078)ࡣࢥࣥࢺ࣮ࣟࣝ⩌ (P=0.567)ẚ࡚᭷ពᨵၿࡋࡓࠋࡲࡓࣚ࢞⩌ࡣ QOL ࡢ SIS ㌟య㡿ᇦ(P=0.01)グ᠈㡿ᇦ (P=0.01)࠾࠸࡚᭷ពᨵၿࡋࡓࠋឤࠊࢥ࣑ࣗࢽࢣ࣮ࢩࣙࣥࠊ♫άືḟඖ࠾࠸࡚᭷ ពᕪࡣ࡞ࡗࡓࠋ ⤖ㄽ ࣚ࢞ࡣᐈほⓗ㐠ືᶵ⬟ᣦᶆࡣᨵၿࡋ࡞ࡗࡓࠋ ࡋࡋάືᛶไ㝈ࡢ࠶ࡿ⬻༞୰ᚋࡢᝈ⪅ ࡢ࣓ࣥࢱࣝ࣊ࣝࢫࡸQOLࢆᨵၿࡍࡿධἲࡋ࡚ࠊࣚ࢞ࡣ᭷ຠᛮࢃࢀࡿࠋᚋࠊ⬻༞ ୰ࡢࣜࣁࣅࣜᑐࡍࡿࣚ࢞ࡢ᭷ຠᛶࢆཝᐦ࡛㐺ṇ࡞RCTࡼࡗ࡚ㄪᰝࡍࡿᚲせࡀ࠶ࡿࠋ Ᏻᛶ㛵ࡍࡿゝཬ Ᏻᛶࡸస⏝㛵ࡍࡿゝཬࡣ࡞࠸ ࢻࣟࢵࣉ࢘ࢺ⋡ࢻࣟࢵࣉ࢘ࢺ⩌ࡢ≉ᚩ ࡞ࡋ ࣚ࢞ࡢヲ⣽ ࢢ࣮ࣝࣉࢡࣛࢫࡢෆᐜ$33(1',;7DEOH$$ࢆཧ↷ࠋ࣮ࢧࢼ㸦ᗙࡢࢿࢥࡢ࣏࣮ࢬࠊ ࡸࡋࡢᮌࡢ࣏࣮ࢬࠊᦂࢀࡿࡸࡋࡢᮌࡢ࣏࣮ࢬࠊ࢚࢘ࢫࢺ࣮ࣟࢸ࣮ࢩࣙࣥࠊࢫࢡ࣡ࢵࢺࠊ❧ ࡢ♳ࡾࡢ࣏࣮ࢬ㸧 ࠊࣉ࣮ࣛࢼ࣮࣮࣐ࣖ㸦⮬↛྾ࡢព㆑ࠊ⭡ᘧ྾ࠊ⬚ᘧ྾ࠊ ྾ἲࠊࢼ࣮ࢹࢩ࣮ࣙࢲࣥ㸧 ࠊ▂㸦࣮࣭ࣚ࢞ࢽ࣮ࢻ࣮ࣛ㸧 $EVWUDFWRU ࡢࢥ࣓ࣥࢺ ⬻༞୰ᚋ∦㯞⑷ᝈ⪅ࡢ㐠ືᶵ⬟ࠊᢚ࠺ࡘ࣭Ᏻࠊ42/ ᑐࡍࡿࣚ࢞ࡢຠᯝࡘ࠸᳨࡚ドࡋ ࡚࠾ࡾࠊ42/ ࡢᨵၿຠᯝࡀ࠶ࡿࡇࡀ♧ࡉࢀ࡚࠸ࡿࠋ୧⩌ඹ ྡࡢ᳨ド࡛࠶ࡾࠊ ᚋࡣᑐ㇟ேᩘࢆᣑࡋ࡚ㄪᰝ࣭◊✲ࢆ㐍ࡵࡿࡇࡀồࡵࡽࢀࡿࠋ $EVWUDFWRU ࡢ᥎ዡᗘ ⬻༞୰ᚋ∦㯞⑷ࡢᝈ⪅ᑐࡋ࡚ࠊࣚ࢞ࢆ᮲௳ࡁ່࡛ࡵࡿ $EVWUDFWRUDQG'DWH ཎ⏣῟ ᒸᏕ − 168 −