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1 대한임상건강증진학회지제 4 권제 2 호 2004 Korean J Health Promot Dis Prev Vol. 4, No. 2, 2004 [ 원저 ] Polar Fitness Test 의타당도와신뢰도 유상호, 손기영, 이연지, 조희경, 조비룡, 허봉렬 서울대학교의과대학가정의학교실 - 요약 - 연구배경 심폐지구력은운동처방을할때매우중요한요소로서이의평가를위해현재최대또는최대하운동부하검사를이용하고있다. 그러나일정한장비와시간그리고노력이요구되는운동부하검사를피검자모두에게시행하기가용이하지않아다른간편한측정법의도입이요구되는실정이다. 본연구는젊은성인남자를대상으로트레드밀검사를이용한최대운동부하검사에서실측한최대산소섭취량으로운동부하없이안정시측정하는 Polar Fitness Test 로추정한최대산소섭취량을비교하여이의타당도를평가하고자하며이의신뢰도도평가하고자한다. 또한최대하운동부하를이용하는전자식에르고미터검사의타당도도아울러평가하고자한다. 방법 21 명의젊고건강한성인남자 ( 평균연령 ±SD=25±2.3) 를대상으로 Polar Fitness Test 를일정한간격으로 2 회반복시행하여추정된최대산소섭취량을구하였고동일한대상에게트레드밀검사를시행하여최대산소섭취량을실측하였다. 반복시행한 Polar Fitness Test 의결과로재검사신뢰도를평가하였고 Polar Fitness Test 와트레드밀검사결과의상관계수로타당도를평가하였다. 그리고최대하운동부하검사인전자식에르고미터검사를동일한대상에게시행하여추정된최대산소섭취량을구하였고실측된최대산소섭취량과의상관계수로타당도를평가하였다. 결과실측한최대산소섭취량 (49.9±5.1ml/kg/min) 과비교하여 Polar Fitness Test(42.4±2.0ml/kg/min) 와전자식에르고미터검사 (38.5±7.2ml/kg/min) 는모두최대산소섭취량을낮게추정하였다. 실측한최대산소섭취량과의스피어만상관계수는 Polar Fitness Test의경우 0.03(P=0.91), 전자식에르고미터검사의경우 0.33(P=0.14) 이었으며반복시행한 Polar Fitness Test의피어슨상관계수는 0.99(P<0.01) 였다. 결 론 젊은성인남자의심폐지구력평가를위하여 Polar Fitness Test를사용하는것은적절하지못할것으로보이며전자식에르고미터검사의사용은그장점을고려하여권고할수있을것이라보인다. 다른성별및연령군에대한연구가필요할것으로사료되며앞으로좀더진보된안정시심폐지구력측정법의개발이필요할것으로사료된다. ( 대한임상건강증진학회지 2004;4:110~115) 중심단어 Polar Fitness Test, 타당도, 신뢰도, 최대산소섭취량, 심폐지구력 9 서론 신체활동과규칙적인운동이고혈압, 당뇨병, 뇌졸중, 심혈관계질환및이로인한합병증과사망률을낮춘다는것은이미여러연구를통해알려져있다. 1-6) 그러나우리나라의경우의사로부터운동을권유받은사람은 8.6% 에불과하다 교신저자 : 조희경서울대학교의과대학가정의학교실 주소 : 서울시종로구연건동 28번지 전화 : heegang71@yahoo.co.kr 접수일 : 2004년 6월 7일 채택일 : 2004년 6월 19일 는연구보고가있었으며 7) 이에반해의사로부터운동을권유받은환자의 76.5% 가과거보다더많은양의운동을한다는연구보고가있었다. 8) 이를고려해볼때일차의료를담당하는가정의는운동에대한상담이나처방을좀더적극적으로해야할것으로보인다. 운동처방을위해서는먼저환자의건강상태와체력수준을정확히평가하여효과적이고안전한운동을처방하여야한다. 체력은신체조성, 심폐지구력, 근골격체력, 유연성등으로이루어져있는데이중심폐지구력은운동하는근육으로산소와영양소를효과적으로전달하는심장과폐그리고 110

2 [Assessment of Validity and Reliability of the Polar Fitness Test] 순환계의능력을말하는데운동처방을할때매우중요한요소이다. 9) 심폐지구력을나타내는가장좋은지표는최대산소섭취량으로알려져있으며 10) 이는운동부하검사를통해측정할수있다. 최대산소섭취량을직접측정하는방법인최대운동부하검사는정확한측정치를얻을수는있으나특수장비와전담인력이필요하고, 피검자가최대한까지운동을하여야하므로상당한시간과노력이요구되어실제로모든사람에게적용하기어렵다. 이에최대산소섭취량을추정하는여러가지최대하운동부하검사와현장검사등이개발되었으나 11-14) 이들역시일정한정도의장비와인력및시간과노력이요구되어운동처방이필요한모두에게시행하기가용이하지않다. 그러므로현재좀더간편하고정확한다른측정법의도입이요구되는실정이다. 이런요구에부응하여안정시심박동수와그변이를이용하여최대산소섭취량을추정하는검사법이개발되고있으며 15) Polar Fitness Test도이중하나다. 핀란드에본사를두고있는 Polar 전자회사가인공신경망계산법을이용하여개발, 제작한심박수측정기를이용하여시행하며안정시심박동수와그변이를추적하여최대산소섭취량을추정한다. 운동중에착용할수있도록시계형태로만들어져매우간편하게사용할수가있어주로프로운동선수의체력향상목적으로사용되어왔으며안정시최대산소섭취량의추정등에도적용해볼수있다. 현재구미인을대상으로한타당도와신뢰도에대한연구는어느정도진행되었으나 16) 한국인을포함한동양인을대상으로한연구는없는실정이다. 본연구는젊은성인남자를대상으로 Polar Fitness Test 를일정한간격으로 2회반복시행하여신뢰도를평가하고자하며트레드밀검사를이용한최대운동부하검사에서실측한최대산소섭취량으로 Polar Fitness Test로추정한최대산소섭취량을비교함으로써 Polar Fitness Test의타당도를평가하고자한다. 또한최대하운동부하검사중하나인전자식에르고미터검사의타당도도아울러평가하고자한다. 1. 연구대상 방법 21명의만 23세에서 30세까지의 (25±2.3세) 젊고건강한성인남자를대상으로하였으며이들의신체지수는표 1에서제시한바와같이신장은 175.5±4.8cm, 체중은 73.6±7.7kg, 체질량지수는 23.9±2.2kg/ m2로서평균적인신장에약간의체 중과다를보였다. 운동여부는유산소운동 ( 예 : 빨리걷기, 달리기, 농구등 ) 을한번에 30분이상하는경우를 1회로적용하여주당횟수로나타내었으며이번연구대상은 2.43±2.22/week 를보였고흡연여부는현재흡연자의수로나타내었으며 1명이었다. 연구대상자는 18명의의대생과 3명의전공의로구성되어있으며전원자원자였다. Table 1. Baseline characteristics of study subjects (N=21) Characteristics Age(years) Height(cm) Weight(kg) BMI(kg/ m2 ) Exercise(No. of exercises/ week)* Smoking(No. of smoker) Mean±standard deviation 25.0 ± ± ± ± ± * In case of exercise, numbers of aerobic exercise which lasts over 30 minutes per week were counted. In case of smoking, current smokers were counted. 2. 연구방법 검사는 2003년 5월부터 6월까지시행하였으며검사중평균온도는 24.7, 습도는 62.1%, 기압은 753.3mmHg 였다. 피검자는검사실시전 24시간내에심한운동과알코올섭취를피하도록하였으며검사 2시간내에식사, 담배, 커피등을금하도록하였다. 1) 최대산소섭취량의실측트레드밀검사법을이용하였으며부루스계획안에따라시행하였다. 운동부하는트레드밀의속도와경사도모두를변경시켜증가시키는데부루스계획안의경우각단계가 3분이며 10% 의경사도와 1.7mph 의속도로시작하여다음단계마다경사도와속도가각각 2% 와 0.8mph 씩증가한다. 17) Quinton사에서제작한 series 90 Q65 모델을사용하였으며 QMC 가스분석기를이용하여최대산소섭취량을실측하였고 Q4500 심박동수와혈압모니터를이용하여혈압과맥박의변화를관찰하고추적하였다. 최대산소섭취량판정기준으로다음 5가지조건이있을수있으며본연구에서는 2가성립되는상황에서 1과 3중하나라도있는경우로규정하였다 : 1운동부하가추가적으로증가되더라도산소섭취량이 150ml/min 이상증가하지않고고원에이르거나오히려감소할때, 2탈진하여더이상진행할수없거나자각적운동강도가보그척도의 17보다높을때, 3운동강도가증가하더라도심박수가증가하지않을때, 4정맥혈의젖산염농도가 8mM/L 를초과할때, 5호흡교환율이 1.15 이상일때이다. 18) 111

3 [Polar Fitness Test 의타당도와신뢰도 ] 2) 최대산소섭취량의추정 (1) Polar Fitness Test 핀란드에서제작된 Polar 심박기 S610i를이용하여최대산소섭취량을추정하였다. 심박수측정기는가슴에착용하는검은띠형태의심장박동반응을감지하는트렌스미터와손목에착용하는시계형태의리시버로이루어져있으며무선전송하는원리로작동한다. 안정시심박동수를기초로하므로측정하기전최소한 20분간은완전휴식을취하게하였다. 시계형태의리시버에피검자의신장, 체중, 생년월일, 성별, 신체활동정도 ( 상중하로구분 ) 를입력하고피검자를의자에편안히앉힌후 15분간격으로 2회반복시행하였으며 1회검사시간은평균 3-5분정도였고추정된최대산소섭취량은리시버의액정에표기되었다. 반복시행한검사결과는실측한최대산소섭취량과의비교를위하여평균을구했다. (2) 전자식에르고미터검사일본에서제작된 CatEye ergociser의 EC 1600모델을이용하였다. 트레드밀검사를시행하지않은다른날피검자에게 1회시행하였다. 대부분의자전거에르고미터검사계획안에서와같이 60-65rpm의페달회전율을사용하였으며운동시간은총 10분이고모니터에피검자의연령, 체중, 성별을입력하면자동으로매 4분과 7분마다증가된운동부하를적용하도록되어있으며각단계의마지막심박동수가측정된다. 이러한운동부하에대한각각의심박수변화를회귀분석으로계산한후외삽법으로최대산소섭취량을추정하며그결과는자동출력되었다. 3. 통계분석 를보였다. 대부분비흡연자였으며하루 30분이상의운동을평균 1주일에 2번하는정도였다 ( 표 1). 2. 최대운동부하검사의결과 트레드밀을이용한최대운동부하검사로실측한최대산소섭취량은 49.9±5.1ml/kg/min 였고최대심박수는 190.4±8.2 회 / 분였다. 이검사결과와연구대상자들의여러특성들과비교해보면체질량지수, 흡연력, 주당운동횟수와의스피어만상관계수는각각 -0.17(P=0.48), -0.16(P=0.49), 0.76(P<0.01) 로최대산소섭취량과주당운동횟수와는유의한상관관계가있었다 ( 표 3). 3. Polar Fitness Test 와전자식에르고미터검사의결과 Polar Fitness Test로 2회반복시행하여추정한최대산소섭취량은각각 42.7±2.0ml/kg/min과 42.1±2.0ml/kg/min으로그평균값은 42.4±2.0ml/kg/min였으며전자식에르고미터검사로추정한최대산소섭취량은 38.5±7.2ml/kg/min 로모두실측한최대산소섭취량보다낮은결과를보였다 ( 표 2). 2회반복시행한 Polar Fitness Test 결과의피어슨상관계수는 0.99(P<0.01) 로매우유의하였다. 실측한최대산소섭취량과의스피어만상관계수는 Polar Fitness Test의경우 0.03(P=0.91) 로유의하지않았고 ( 그림1), 전자식에르고미터검사의경우 0.33(P=0.14) 로역시유의하지않았다 ( 표 3). 주당운동횟수와의스피어만상관계수는 Polar Fitness Test의경우 -0.07(P=0.76) 로유의하지않았고, 전자식에르고미터검사의경우 0.41(P=0.07) 로어느정도유의하였다 ( 표 3). 타당도와신뢰도를평가하기위하여비교값의상관계수를구하였으며통계처리는윈도우용 SPSS 11.0 영문판으로시행하였다. 결과 1. 연구대상자의특성 연구대상자 21명은평균연령이 25±2.3세인심폐기능에이상이없는건강한남자로서 18명의의과대학생과 3명의전공의로구성되어있으며신장은 175.5±4.8cm, 체중은 73.6±7.7kg, 체질량지수는 23.9±2.2kg/ m2로서평균신장에약간의체중과다 Figure 1. Correlation between VO 2max values by Treadmill test and average VO 2max values by Polar Fitness Test.* *r=0.03(p=0.91) 112

4 [Assessment of Validity and Reliability of the Polar Fitness Test] Table 2. Mean VO 2max values of Polar Fitness Test, Electronic Ergometer and Treadmill Test. Test modalities Polar Fitness Test 1 st (N=21) Polar Fitness Test 2 nd (N=21) Electronic Ergometer (N=21) Treadmill Test (N=21) 고찰 VO 2max values (mean±standard deviation) 42.7±2.0ml/kg/min 42.1±2.0ml/kg/min 38.5±7.2ml/kg/min 49.9±5.1ml/kg/min 본연구에서는 Polar Fitness Test를한국인에게임상적으로적용하기전에그타당도와신뢰도를평가하기위하여최대운동부하검사인트레드밀검사의결과와비교분석하였다. 그리고현재임상적으로널리사용하고있는최대하운동부하검사인전자식에르고미터검사의타당도도함께평가해보았다. 본연구의가장주요한의의를들자면안정시심폐지구력을측정할수있는검사기기의타당도를한국인에게최초로평가해본것일것이다. 연구결과에서밝혔듯이트레드밀최대운동부하검사로실측한최대산소섭취량보다 Polar Fitness Test와전자식에르고미터검사로추정한최대산소섭취량이 15-23% 정도낮은결과를보였다. 이는아마도최대하운동부사검사와안정시검사의가정인심박수와산소섭취가직선적인관계가있다는것과는다르게실제로큰운동량에서심박수의증가에비해산소섭취량의증가가더크기때문에실측치에비해낮게추정된것으로보인다. 19,20) 트레드밀검사결과와연구대상자의여러특성들을비교해보면체질량지수와흡연력과의스피어만상관계수는각각 (P=0.48), (P=0.49) 로유의한상관관계가없는것으로나타났으나, 주당운동횟수와의스피어만상관계수는 0.758(P<0.01) 로둘사이에는유의한상관관계가있었다. 향상된심폐지구력이유산소운동프로그램의가장중요한효과인것처럼당연한결과로사료 된다 ( 표 3). Polar Fitness Test의경우두번반복한결과의피어슨상관계수는 0.99(P<0.01) 로매우유의하였으며실측한최대산소섭취량과의스피어만상관계수는 0.03(P=0.91) 로유의하지않았다 (Table 3). 주당운동횟수와의스피어만상관계수는 -0.07(P=0.76) 로역시유의하지않았다. 신뢰도는매우높으나타당도가낮아최대산소섭취량의절대값의추정을위해임상에적용하기에는무리가있으나 Polar 심박기의개발자도지적하였듯이안정시최대산소섭취량을파악하는것보다는일정한기간동안유산소운동을시행하고난후산소섭취량의변화를측정하는데에는이용할수있을것으로보인다. 21) 전자식에르고미터검사의경우실측한최대산소섭취량과의스피어만상관계수는 0.33(P=0.14) 로유의하지않았으나연구대상자의수를늘이면유의성이증가할것으로예상된다. 주당운동횟수와의스피어만상관계수는 0.41(P=0.07) 로유의한결과를보였다. 현재가장널리사용되고있는전자식에르고미터검사는그타당도가국내의다른연구에서는어느정도입증되었고 22) 트레드밀검사에비해적은공간을차지하고소음이적으며운동량이많지않고어느정도는쉽게시행할수있는장점이있으므로이를고려하여임상에서의적용을권고할수있을것으로사료된다. 이번연구의가장큰한계점은연구대상자의수가적고특정한연령과성별에국한되어있다는것인데최대운동부하검사의특성상심폐기능에문제가없는건강한사람에게시행할수밖에없는제한점이있으나좀더적극적으로연구대상자의범위를넓힐필요가있겠다. 결론적으로이번연구를통해 Polar Fitness Test를최대산소섭취량의절대값을측정하는목적으로임상에적용하기에는무리가있다는것을파악하게되었으며앞으로좀더진보된안정시심폐지구력측정법의개발이필요할것으로사료된다. Table 3. Correlations between measured VO 2max values with predicted values and other characteristics. Correlation coefficients* Polar Fitness Test Treadmill Test Electronic Ergometer Polar Fitness Test (P=0.91) 0.16(P=0.48) Electronic Ergometer (P=0.14) - BMI(kg/ m2 ) -0.15(P=0.51) -0.17(P=0.48) -0.20(P=0.38) Exercise(numbers/week) -0.07(P=0.76) 0.76(P<0.01) 0.41(P=0.07) Smoking 0.15(P=0.52) -0.16(P=0.49) -0.04(P=0.86) 113

5 [Polar Fitness Test 의타당도와신뢰도 ] 참고문헌 1. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB. Physical activity, all cause mortality, and longevity of college alumni. N Engl J Med 1986;314: Harris SS, Caspersen CJ, DeFriese GH, Estes EH. Physical activity counseling for health adult as a primary preventive intervention in clinical setting. JAMA 1989; 261(24): Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992;286: Rodriguez BL, Curb D, Burchfiel CM, Abbott RD, Petrovitch H, Masaki K, et al. Physical activity and 23-year incidence of coronary heart disease morbidity and mortality among middle-aged men: the Honolulu Heart Program. Circulation 1994;89: Abbott RD, Rodriguez BL, Burchfiel CM, Curb JD. Physical activity in older middle-aged men and reduced risk of stroke: the Honolulu Heart Program. Am J Epidemiol 1994;139: Blair SN, Kampert JB, Kohl HW III, Barlow CE, Macera CA, Paffenbarger RS, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276: 신호철. 건강한생활습관에대한의사의권고 : 심혈관계위험요인을중심으로. 가정의학회지 2001;22(11): Greenlund KJ, Giles WH. Keenan NL, Croft JB, Mensah GA. Physician advice, patient actions and health-related quality of life in secondary prevention of stroke through diet and exercise. Stroke 2002;33(2): Heyward VH. 장경태, 최대혁, 박현, 고영한, 이대택, 김상원역. 체력평가와운동처방. 개정판. 서울 : 한미의학 ; 대한스포츠의학회. 스포츠의학. 서울 : 의학출판사 ; Bailey DA, Shepahard RJ, Mirwald RL. Validation of a self-administered home test of cardiorespiratory fitness. Can J Appl Sports Sci 1976;1: 최창진, 김경수, 옥선명, 송찬희, 염근상, 박은숙등. 젊은성인남자의유산소능력측정에있어서 4가지최대하운동부하검사의타당도비교. 가정의학회지 1999;20(12): Oja P, Laukkanen R, Pasanen M, Tyry T, Vuori I. A 2-km walking test for assessing the cardiorespiratory fitness of healthy adults. Int J Sports Med 1991:12(4): Laukkanen RM, Oja P, Ojala KH, Pasanen ME, Vuori IM. Feasibility of a 2-km walking test for fitness assessment in a population study. Scand J Soc Med 1992:20: Achten J., Jeukendrup AE. Heart rate monitoring. Sports Med 2003;33(7): Peltola, Hannula, Held, Kinnunen, Nissila, Laukkanen, et al. Validity of Polar Fitness Test based on heart rate variability in assessing VO 2max in trained individuals. Proceedings of 5th annual congress of ECSS; 2000 Jul 19-23; Jyvfaskyla, Finland. 17. Heyward VH. 장경태, 최대혁, 박현, 고영한, 이대택, 김상원역. 체력평가와운동처방. 개정판. 서울 : 한미의학 ; American College of Sports Medicine. ACSM s guidelines for exercise testing and prescription. 5 th ed. Baltimore: Williams & Wilkins; Rowell Lb, Taylor HL, Wang Y. Limitation to prediction of maximal oxygen intake. J Appl Pysiol 1967;23: Davies CT. Limitation of maximal oxygen uptake from cardiac frequency measurementrs. J Appl Physiol 1968; 24: R & D, Polar Electro Oy. Scientific development and evaluation of the Polar Fitness Test. Finland;Dec. 7, 김경수, 이손호, 김경미, 옥선명, 송찬희, 김홍인. 젊은성인남자의유산소능력측정에있어서최대하고정식자전거검사법의신뢰도와정확도. 가정의학회지 1996;17(3):

6 Korean J Health Promot Dis Prev Vol. 4, No. 2, 2004 [Abstract] Assessment of Validity and Reliability of the Polar Fitness Test Sang Ho Yoo, Ki Young Son, Yeon Ji Lee, Hee Kyung Cho, Bee-Ryong Cho, Bong Yul Huh Department of Family Medicine, Seoul National University Hospital Background Exercise load tests have been used for evaluation of cardiorespiratory fitness. However, they are not applicable to everyone because of special equipments to conduct and considerable time and efforts from testees. Therefore, simpler yet accurate ways of evaluation are being badly in need and Polar Fitness Test can be one of them. In this study predicted VO2max values during resting state with the Polar Fitness Test are being compared with measured VO2max values(criterion VO2max) determined during the maximal treadmill test in order to assess the validity and the reliability of the Polar Fitness Test. In so doing, the validity of the Electronic Ergometer is assessed as well. Methods Twenty one of healthy young-aged males(m±sd=25±2.3years) were volunteered for this study. Criterion VO2max values were determined during the maximal treadmill test while predicted values were achieved twice with the Polar Fitness Test at an interval of fifteen minutes. Then the correlation coefficients were calculated with the SPSS 11.0 program whether the Polar Fitness Test is valid and reliable. Same protocol was applied for the Electronic Ergometer as well. Results All the predicted VO2max values were lower than the measured values (Treadmill test: 49.9±5.1ml/kg/min; Polar Fitness Test: 42.4±2.0ml/kg/min; Electronic Ergometer: 38.5±7.2ml/kg/min). The correlation coefficients between the measured and predicted VO2max values with the Polar Fitness Test and the Electronic Ergometer were 0.03(P=0.91) and 0.33(P=0.14) respectively. The correlation coefficient between two repeated values with the Polar Fitness Test was 0.995(P<0.01). Conclusions These results suggest that the Polar Fitness Test should not be recommended for estimating VO2max values in young adults, but the Electronic Ergometer could be considered for recommendation. Further studies on female and other age groups are needed to confirm these results from young male subjects.(korean J Health Promot Dis Prev 2004 ; 4 : 110~115) Key words Polar Fitness Test, validity, reliability, maximal oxygen consumption(vo2max), cardiorespiratory fitness 10 Address for correspondence : Hee Kyung Cho Department of Family Medicine, Seoul National University Hospital T e l : heegang71@yahoo.co.kr 115

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