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가상현실운동프로그램이여성노인의근활성도와균형능력에미치는영향 이준희, 박성웅, 강정일, 양대중, 박승규 The Journal of Korean Society of Physical Therapy 이준희, 박성웅 1, 강정일, 양대중, 박승규 대불대학교보건대학원, 1 대불대학교보건대학원물리치료전공 Effects of Virtual Reality Exercise

1 가상현실운동프로그램이여성노인의근활성도와균형능력에미치는영향 이준희, 박성웅, 강정일, 양대중, 박승규 The Journal of Korean Society of Physical Therapy 이준희, 박성웅 1, 강정일, 양대중, 박승규 대불대학교보건대학원, 1 대불대학교보건대학원물리치료전공 Effects of Virtual Reality Exercise Program on Muscle Activity and Balance Abilities in Elderly Women Joon hee Lee, PT, PhD; Seong ung Park, PT 1 ; Jeong il Kang, PT, PhD; Dae jung Yang, PT, PhD; Seung Kyu Park, PT, PhD School of Public Health, Daebul University; 1 Department of Physical Therapy, School of Public Health, Daebul University Purpose: The aim of this study was to investigate the effects of an exercise program using a virtual reality game and a gait exercise program using a treadmill on % maximum voluntary isometric contraction (%MVIC) and static and dynamic balancing capabilities. Methods: A total of 26 elderly women were included in the study. 13 women were assigned to an exercise program using a virtual reality game, and 13 to a gait exercise program using a treadmill. The subjects performed the exercise for 40 min per session, three sessions per week, for eight weeks. Results: The %MVIC of the vastus medialis was significantly increased from 28.91±2.03% to 32.98±2.6% in the virtual reality game exercise group (p<0.00). The %MVIC of the vastus lateralis was significantly increased from 27.17±1.93% to 31.50±2.18% (p<0.00) in the gait exercise program group. The whole path length with both feet on the floor and eyes open was significantly decreased from ±820.6 mm to ± mm (p<0.00). The whole path length with both feet on the floor and eyes closed was significantly decreased from ± mm to ± mm (p<0.00). The length of a functional reach was significantly increased from 25.2±4.23 cm to 27.68±4.04 cm (p<0.00). Conclusion: The exercise program using a virtual reality game is effective for improving the %MVIC and static and dynamic balancing capabilities in elderly women aged 65 years and more. Keywords: Virtual reality, Muscle activity, %MVIC, Static balance, WPL, Dynamic balance, FRT 논문접수일 : 2011년 6월 1일수정접수일 : 2011년 8월 8일게재승인일 : 2011년 8월 12일교신저자 : 박성웅, psu0805@hanmail.net I. 서론최근조사에의하면노인의주요사망원인이었던순환기질환이나호흡기질환과같은만성질환은점차감소하고있으나오히려노인들의건강은향상되어활동이증가하고생활이다양해지면서각종사고로인한사망은전체노인사망의약 15% 를차지하게되었다. 특히낙상사고가운수사고나자살사고보다많아사고로인한사망의 70% 가낙상과관련된사망인것으로조사되었다. 1 낙상은갑작스러운마비나발작, 외압에의해넘어지는것을제외하고자신이의도하지않은자세변화로인해몸이 더낮은위치로넘어지는것을말하는데, 넘어짐으로인해상해가발생하지않는다하더라도잦은넘어짐은노인들의신체활동및사회활동에많은지장을초래한다. 2,3 실제적으로신체활동은활동적인노년을유지하는데유용한전략이며규칙적인신체활동이노인의능동적이고독립적인삶을연장시켜줄뿐만아니라장애를감소시키고, 삶의질을향상시킬수있다는과학적근거가증가하고있다. 4 그러나 2009년국민건강통계에따르면노인의격렬한신체활동실천율은 60~69세남성은 17.8%, 여성은 13.5%, 70세이상남성은 9.9%, 여성은 6.0% 이었고, 중등도이상신체활동실천율은 60~69세남성은 24.2%, 여성은 가상현실운동프로그램이여성노인의근활성도와균형능력에미치는영향 37

2 J Kor Soc Phys Ther 2011;23(4): %, 70세이상남성은 21.5%, 여성은 13.8% 로나타났다. 1 이러한수치는우리나라노인, 특히여성노인의신체활동수준이매우낮음을보여준다. 신체활동의감소, 즉신체기능의비사용으로인한근질량감소증 (Sarcopenia) 이유발되는데, 운동이부족한노인들은근위축이나골밀도의저하가촉진되고, 노화로인한퇴행성변화는균형조절에손상을초래한다. 5,6 이는곧노인에게있어근력및균형능력에저하가나타나낙상의위험성을증가시키므로하지근력의증진운동및균형훈련을통한노인의균형능력을증가시켜노인의낙상예방이필요하다. 7 낙상예방및건강을증진하기위해운동효과를제시한선행연구들을보면규칙적인걷기운동, 근력의증진운동, 균형훈련이노인의낙상을예방하는데효과적이라하였다 특히걷기는노인들에게있어가장인기있고안전한유산소운동으로조사되었으며, 노인들에게적절한운동강도, 운동빈도, 운동기간, 운동단계를고려하여노인의운동적응능력에따라점진적으로진행할수있으며, 일상생활활동에도움을준다고보고하고있다 ~90세의노인 81명을대상으로규칙적인걷기운동을통해의자에서앉았다일어나기, 3 m 왕복걷기검사, 선자세에서팔뻗기, 6분걷기, 보행속도모두유의한향상을가져왔다. 13 최근에는트레드밀을이용한훈련이평지에서의보행훈련의비교에서트레드밀훈련이보다높은효과가있음이밝혀져트레드밀을사용한보행훈련의효율성이더욱강조되고있다 ~98세의노인을대상으로트레드밀트레이닝을실시한결과균형이유의하게향상되었고, 트레드밀에서의걷기운동은보행능력향상과균형훈련자극이있으며, 낙상을예방할수있어효과적이다 근래에들어서컴퓨터프로그램의개발과더불어환자개인의목적에맞는다양한형태의과제를가상의환경에서수행하여치료의흥미와참여도를높이고유의한기능의향상을보인새로운재활운동방법이소개되었다. 18,19 가상현실 (Virtual Reality) 이란컴퓨터하드웨어와소프트웨어를통하여사용자에게실제와비슷한경험을하도록만든대화형시뮬레이션 (interactive simulation) 을말한다. 20 최근들어서접근성이용이한가상현실을기반으로한게임을이용한연구들이진행되어지고있는데치료용게임은의료적차원에서가상현실을이용하는치료게임을말하는데, 가상현실프로그램을뇌성마비아동에게적용한결과수의적조절능력과협응능력의모든항목에서점수가상승하였으며, 파킨슨씨병환자에게적용한결과무운동증 (akinesia) 이감소하여운동기능의향상에효과를보였고, 뇌졸중환자에게적용한결과상지기능회복에효과적이라고하였으며, 균형능력과보행속도향상및일상생활능력에효과적이라고하였다 소수의신경계손상환자외에노인을대상으로가상환경움직임이균형훈련및평가도구로활용될수있다고하 였고, 노인의인지기능향상, 근력및보행능력향상, 균형능력향상에효과적인중재방법으로사용되어질수있는가능성을제시하였다. 27,29-31 그러나지금까지의연구되어진가상현실을실현하는장비들은대형장비들로구성되어비용이나규모가일반적인사회시설이나가정에서적용하기에는다소어려움이있고소수의환자들을대상자로하였으며노인의근력및균형능력의검사방법에있어서더욱정량화되고객관적인실험장비를사용하지않아결과를일반화하기에는어려움이있었으며, 동일한조건의대조군을설정하지않았다는것이다. 이에본연구자는 65세이상여성노인을대상으로시설과장소와기후에구애없이언제, 어디서나쉽고재미있게수행할수있는가상현실운동프로그램을실시하여 65세이상여성노인의하지근육의근활성도및균형능력에미치는영향을검증하고낙상의위험에노출되어있는노인의건강증진을도모하는낙상예방프로그램의기초를제공하고자시도하였다. II. 연구방법 1. 연구대상 본연구의연구대상은전남목포시에소재한 H 보건지소를이용하는 65세이상여성노인을대상으로의사소통이가능하고독립적인보행이가능하며운동수행에제한을주는통증이없으면서균형에영향을미칠만큼심각한근골격계장애가없고본연구에관한충분한설명을듣고연구참여에자발적인동의가있는자를대상으로여성노인 26명을선정하였고, 가상현실운동프로그램그룹 ( 실험군 ) 13명과트레드밀을이용한걷기운동프로그램그룹 ( 대조군 ) 13명으로무작위임의선정되었으며연구대상자의일반적특징은 Table 1과같다. Table 1. General characteristics in the Virtual Reality and Treadmill Gait exercise program group VREP group (n=13) M±SD TGEP group (n=13) F p-value M±SD Age (year) 70.7± ± Height (cm) 153.7± ± Weight (kg) 57.3± ± VREP: Virtual Reality exercise program TGEP: Treadmill Gait exercise program 38 Effects of Virtual Reality Exercise Program on Muscle Activity and Balance Abilities in Elderly Women

3 이준희, 박성웅, 강정일, 양대중, 박승규 2. 실험방법 본연구는실험기간동안실험군에는가상현실운동프로그램을대조군에는트레드밀을이용한걷기운동프로그램을중재하였으며 8주동안주 3회, 1회중재시 40분의중재를받았다. 가상현실운동프로그램은일본 Nintendo사에서제작한 Wii-Fit 소프트웨어를사용하였으며가상현실모션감지시스템을통해플레이어가화면에서의아바타와상호작용하는무선컨트롤러를사용하는방식이다. 컨트롤러에는프로그램을실행함에있어서방향과속도를인식할수있도록가속도변화에반응하는가속도감지센서가부착되어있다. 이연구에사용된가상현실시스템은 Wii보드밸런스시스템으로균형판이체중의이동정보와분포도를인식하여게임을진행하는방식이다. 흥미도및만족도설문지분석을토대로요가의의자자세, 근력운동의무릎굽혀당기기, 유산소운동의조깅, 밸런스게임의헤딩으로각한프로그램씩구성되었으며, 트레드밀을이용한걷기운동프로그램은재활전용저속트레드밀 (Goliath-705, Ho-jin, 한국 ) 로계기판이전면에위치하여환자의걷기능력에따라서환자스스로 0.1 km/hr씩조절이가능하도록구성되었다. 속도는 0.1 km/hr부터시작이되며, 속도조절은 0.1 km/hr씩가능하다. 전면과양측면에손잡이가장착되어있어걷기훈련중균형을잃을경우손으로잡도록되어있다. 1) 측정도구 (1) 표면근전도시스템하지의근활성도를측정하기위해표면근전도시스템 (MP100, 미국 ) 을이용하였고여기에서전환된디지털신호는개인용컴퓨터에서 Acqknowledge 3.91 소프트웨어를이용하여자료처리하였다. 신호의표본추출률 (sampling rate) 은 1,024 Hz로설정하였고, 잡음을최소화하기위하여대역여과필터 60 Hz, 대역통과필터 30~450 Hz를사용하였고, 수집된신호는완파정류한후 RMS (root mean square) 처리를하였다. 각근육들의활동전위를표준화하기위해맨손근력검사자세에서최대등척성수축시의근활성도를측정하였다. 5초동안 3번의자료값을측정한후초기와마지막 1를제외한 3초동안의평균근전도신호량을 %MVIC로사용하였다. 표면근전도신호에대한피부저항을감소시키기위하여부착부위의털을제거하고 Table 2. Electrodes location Muscle Vastus medialis Vastus lateralis Location Approximately 6 cm above the patella, on an oblique angle just medial to midline. Approximately 8 to 10 cm above the patella, on an oblique angle just lateral to midline. 가는사포로 3~4회문질러피부각질층을제거한후, 소독용알코올로피부를깨끗이하였다. 이극표면전극을측정하고자하는근육에부착하였고접지전극 (ground electrode) 은손목에부착하였다. 측정근육은안쪽넓은근, 가쪽넓은근이며측정부위는 Table 2와같다. (2) 균형측정시스템정적균형능력측정을위해 active balancer system (EAB-100, 일본 ) 을이용하였으며본장비는측정시간동안신체압력중심 (center of pressure, COP) 의이동거리를정밀하게측정할수있는기계이다. 검사방법에는시각을제외하여균형능력을측정할수있는방법으로눈을뜬상태와감은상태에서양쪽발로서기검사를사용하였고측정은 60초동안 3회를측정하여얻은결과값의평균값을이용하였다. 균형능력의분석은압력중심의총이동거리인총궤적길이 (whole path length, WPL) 를이용하였다. (3) 기능적팔뻗기검사동적균형능력측정을위한기능적팔뻗기검사 (functional reach test, FRT) 는선자세에서균형을잃지않도록유지하면서팔을전방으로뻗는거리를측정하는측정법으로이검사시피험자는편안하게선자세에서발뒤꿈치가떨어지지않는상태로가능한멀리전방으로팔을뻗도록한다. 이때팔의이동을시작부터끝까지벽에붙여놓은줄자로측정한다. 3. 자료분석그룹간훈련방법에따른각근육들의근활성도와균형능력의차이를비교하기위하여공분산분석 (analysis of covariance, ANCOVA) 을실시하였고, 각그룹내의중재전 후에통계학적유의성을검증하기위하여짝비교 T-검정 (paired t-test) 을실시하였으며, 통계학적유의수준은 p<0.05로정하였고, 수집된자료는윈도용 SPSS 17.0 프로그램을이용하여분석하였다. III. 결과 1. 가상현실운동프로그램과트레드밀을이용한걷기운동프로그램그룹간전 후근활성도비교 그룹간의중재전 후안쪽넓은근의근활성도비교에서가상현실운동프로그램그룹이 28.91±2.03% 에서 32.98±2.6% 로트레드밀을이용한걷기운동프로그램그룹과비교하여통계학적으로유의한차이가없었다. 하지만가쪽넓은근의근활성도는 27.17±1.93% 에서 31.5±2.18% 로트레드밀을이용한걷기운 가상현실운동프로그램이여성노인의근활성도와균형능력에미치는영향 39

4 J Kor Soc Phys Ther 2011;23(4):37-44 Table 3. Comparison muscle activity (%MVIC) of each groups by exercise method (unit: %) VREP group(n=13) TGEP group(n=13) pre-test post-test pre-test post-test M±SD M±SD M±SD M±SD F p-value VM 28.91± ± ± ± VL 27.17± ± ± ± * *p<0.01 VREP: Virtual Reality exercise program TGEP: Treadmill Gait exercise program VM: Vastus Medialis VL: Vastus lateralis 동프로그램그룹과비교하여통계적으로유의한차이가있었다 (p<0.01)(table 3). 2. 가상현실운동프로그램과트레드밀을이용한걷기운동프로그램간전 후정적균형능력비교 그룹간의중재전 후정적균형능력비교에서양쪽발을올려놓고눈을뜬상태에서가상현실운동프로그램그룹의총궤적길이 (WPL) 는 ± mm에서 ± mm 로트레드밀을이용한걷기운동프로그램그룹과비교하여통계적으로유의한차이가있었으며 (p<0.01), 양쪽발을올려놓고눈을감은상태에서가상현실운동프로그램그룹의총궤적길이 (WPL) 는 ± mm에서 ± mm로트레드밀을이용한걷기운동프로그램그룹과비교하여통계적 으로유의한차이가있었다 (p<0.00)(table 4). 3. 가상현실운동프로그램과트레드밀을이용한걷기운동프로그램간전 후동적균형능력비교 그룹간의중재전 후동적균형능력비교에서가상현실운동프로그램그룹의팔을전방으로뻗는거리 25.2±4.23 cm에서 27.68±4.04 cm로트레드밀을이용한걷기운동프로그램그룹과비교하여통계적으로유의한차이가있었다 (p<0.00)(table 5). Table 4. Comparison static balance (WPL) of each groups by exercise method (unit: mm) VREP group (n=13) TGEP group (n=13) pre-test post-test pre-test post-test M±SD M±SD M±SD M±SD F p-value BO ± ± ± ± * BC ± ± ± ± *p<0.01 p<0.001 VREP: Virtual Reality exercise program TGEP: Treadmill Gait exercise program VM: Vastus Medialis VL: Vastus lateralis Table 5. Comparison dynamic balance (FRT) of each groups by exercise method (unit: cm) VREP group (n=13) TGEP group (n=13) pre-test post-test pre-test post-test M±SD M±SD M±SD M±SD FRT 25.2± ± ± ± * *p<0.001 VREP: Virtual Reality exercise program TGEP: Treadmill Gait exercise program F p-value 40 Effects of Virtual Reality Exercise Program on Muscle Activity and Balance Abilities in Elderly Women

5 이준희, 박성웅, 강정일, 양대중, 박승규 IV. 고찰본연구에서는 8주간의가상현실운동프로그램이트레드밀을이용한걷기운동프로그램과비교했을때, 하지근활성도와균형능력에미치는영향을알아보고자본연구를실시하였다. 가상현실운동프로그램의목적인낙상의예방효과를알아보기위하여하지근력중노인에게있어서근력, 정적및동적균형능력의결정인자인넙다리네갈래근의우세측안쪽넓은근과가쪽넓은근의근활성도를중심으로운동전 후를측정 분석하였으며, 그결과가상현실운동프로그램그룹의안쪽넓은근은증진되어통계학적으로유의한차이를보였으며 (p<0.00), 트레드밀을이용한운동프로그램그룹과의비교에서안쪽넓은근과는통계학적으로유의한차이가없었지만가쪽넓은근에서는유의한차이가있는것으로나타났다 (p<0.01). Hesse 32 는트레드밀을이용한걷기운동프로그램은일반적지면보행과비교하였을때하지근을좀더활성화시키는효과가있어중재전 후에서하지근활성도의유의한증가를가져왔지만 (p<0.00) 트레드밀을이용한걷기운동프로그램이가상현실운동프로그램그룹의유사한조깅프로그램이있고그에더하여다양한프로그램의선정이가상현실운동프로그램그룹의하지근활성도에더큰영향을미쳤다고판단된다. Park 33 등은 19명의노인에게 4주간하지근력강화운동프로그램을적용한후하지근력이 8.34±1.33 kg에서 14.03± 4.33 kg으로증가되었고, Park 34 등은노인 40명에게 8주간점진적저항운동을적용한후슬관절폄힘이 380.3±170.4kg에서 497.0±178.2kg로증가되었으며, Yoo 35 은 41명의노인을대상으로 Home Support Exercise Program (HSEP) 를적용한낙상예방프로그램을적용한후무릎폄근인넙다리네갈래근의근력이 9.96 kg에서 kg으로근력이증진되었다. Lim 36 은여성노인 45명을대상으로넙다리네갈래근을원심성수축시키는런지 (lunge) 및스쿼트 (squat) 와같은동작인택견품밟기운동을 12주간주 3회실시한후넙다리네갈래근의최대등척성수축 (MVC) 및근력에유의한증진을보였다. 이러한결과는본연구에서도비슷한근력증진을보였는데노인을대상으로실시한품밟기운동이본연구의가상현실운동프로그램중요가의의자자세및근력운동의무릎굽혀당기기동작과유사하며결과에서도비슷한근력의증진을보였다. 또한본연구에서와같은가상현실게임으로연구되어진 Song 27 등의연구사례에서보면가상현실그룹의슬관절폄근인좌측넙다리네갈래근의근력이 17.11±3.04 kg에서 21.66±4.35 kg로우측넙다리네갈래근의근력이 18.38±3.24 kg에서 21.44±3.47 kg로통계학적으로유의한차이가있었다고연구결과확인되었다. 그러나, 대상자의선정에있어서선행연구와다르게본연구에서 는여성노인만을대상자로하였고가상현실운동프로그램과운동방법이다르며프로그램을선정하기전흥미도와만족도를조사한후운동프로그램을선정하였기때문에본연구와차이점이있어선행연구와결과를같이비교하여해석하기에는무리가있다고사료된다. Kim 37 등은 65세이상노인 14명을대상으로가상현실운동프로그램을적용하여눈을뜬상태의자세동요면적이 ± mm²² 에서 ± mm²² 로감소하여통계학적유의한차이를나타냈지만, 눈을감은상태에서는자세동요면적이증가되어통계학적으로유의한차이를나타내지는않았으며, Yoo 35 은 41명의노인을대상으로낙상예방프로그램을적용한후눈을뜨고외다리기립자세에서 6.75 초에서 11.10초로, 눈을감은상태에서는 2.45초에서 4.10초로향상되었고, Lee 38 등은노인 15명을대상으로치료적운동을실시한후외다리기립자세에서 8.72±7.31초에서 11.39±6.57초로증가하였다. Song 27 등은 48명의노인을대상으로 8주동안가상현실운동을이용하여균형능력에미치는영향에대한연구에서가상현실운동후의눈을뜬상태에서와눈을감은상태의자세동요는가상현실운동그룹의좌 우, 전체자세동요에서만유의하게감소하였고 (p<0.05), 대조그룹의경우전 후자세동요에서유의하게증가되었으며 (p<0.05) 그룹간비교에서도유의한차이를나타냈다 (p<0.05). Hong 31 은 20명의노인을대상으로 6주동안가상현실운동을이용하여균형능력에미치는영향에대한연구검사결과균형훈련전 후각각통계학적으로유의한차이를나타내었고, 눈을뜬상태에서의경우오른발외다리기립자세는 16.1±15.98초에서 23.9±18.1초로, 왼발은 12.6±11.8초에서 21.8±14.9초로통계학적으로유의하였지만 (p<0.05), 눈을감은상태에서오른발은 3.4±1.8초에서 4.8±2.8초로, 왼발은 3.4±2.2초에서 5.0±3.2초로통계학적으로유의성이없었다. 위연구와마찬가지로본연구에도정적균형을평가하기위해눈을뜬상태와감은상태에서양쪽발로서서 60초동안유지하는동안의총궤적길이를계산하였다. 가상현실운동프로그램그룹의전 후총궤적길이에대한분석에서눈을뜬상태와감은상태에서의총궤적길이가감소하여정적균형능력의향상을보였으며, 통계학적으로유의한차이를보였다 (p<0.00). 트레드밀을이용한운동프로그램그룹에서는운동전 후총궤적길이에대한분석에서눈을뜬상태에서는통계적으로유의한차이를보였지만 (p<0.00), 눈을감은상태에서는통계적으로유의하지못했다. 각중재그룹간에통계적유의성을검정한결과눈을뜬상태에서의총궤적길이 (p<0.01) 와눈을감은상태에서의총궤적길이 (p<0.00) 모두통계학적으로유의한차이를보였지만, 눈을감은상태에서의총궤적길이가통계학적유의한차이를더보였다. 이는선행연구와그룹내전 후비교에서는일치하였지만, 그룹간비교에서는일치하지않았다. 가상현실운동프로그램이여성노인의근활성도와균형능력에미치는영향 41

6 J Kor Soc Phys Ther 2011;23(4):37-44 그이유는선행연구들에서는대조군을선정하지않았지만본연구에서는대조군에트레드밀을이용한걷기운동프로그램을선정하여균형에영향을주는하지근력의증가와고유수용성감각계의밀접한관계가있는것으로사료된다. Han 39 등은 8주간여성노인 24명을대상으로탄성밴드와스위스볼을중재하여기능적팔뻗기길이가 11.01±4.08 cm에서 13.68±4.11 cm로증진하였으며, Lee 38 등은노인 15명을대상으로기능적팔뻗기길이가 19.44±2.65 cm에서 20.91± 2.49 cm로증진되었다. Song 27 등은기능적팔뻗기검사에서가상현실운동그룹의전 후비교에서통계학적유의한차이를보였으며 (p<0.05), 대조그룹의경우유의한차이를보이지않았지만, 그룹간비교에서는유의한차이를나타냈다 (p<0.05). 본연구에서는가상현실운동프로그램그룹의전 후비교에서유의한차이를보였고 (p<0.00), 트레드밀을이용한걷기운동프로그램그룹내전 후비교에서는유의한차이를보이지않았다. 그룹간비교에서는선행연구와유사하게유의한차이를보였다 (p<0.00). Ribeiro 40 등은기능적팔뻗기검사는발바닥굽힘근근력의유의한증가와밀접한관계가있고가상현실운동프로그램중요가의의자자세와유산소운동의조깅이발바닥굽힘근의쓰임을가져와기능적팔뻗기길이가유의하게증진된것으로사료되고, 트레드밀을이용한걷기운동프로그램에서의발바닥굽힘근의쓰임이동적균형능력의증진에도움을준것으로사료된다. 이러한결과로미루어볼때가상현실운동프로그램그룹과트레드밀을이용한걷기운동프로그램그룹모두균형이좋아진이유는안쪽넓은근, 가쪽넓은근의근력상승과체간근육의근활성화로인한선행적자세조절이이루어짐으로써, 자세동요가감소한것으로사료된다. 위와같은결과들로가쪽넓은근과안쪽넓은근의강화와정적 동적균형능력을요구하는노인에게저항성운동과유산소운동이복합되어진가상현실운동프로그램이흥미를유도하여계획적이고지속적으로노인의건강증진을도모하는낙상예방프로그램으로적합하다고생각된다. 선행연구들의결과와마찬가지로, 본연구에서도가상현실운동프로그램이여성노인의근활성도와균형능력을향상시키는데효과적인것으로나타났지만결과를해석함에있어서몇가지제한점을가지고있다. 첫째, 연구대상의선정에서특정지역의여성노인을대상으로하였다. 둘째, 대상자의수가적었기때문에모든여성노인대상자에게운동의효과를일반화하는데는다소어려움이있었다. 셋째, 본실험실이외의가정이나타시설에서의운동이여성노인의근활성도와균형능력에미치는영향을고려하지않았기때문에연구의결과를일반화하여해석하는데는어려움이있다. 그러므로본연구의결과를일반화시키기위해서는향후이러한제한점을보완하는연구들이 계속적으로이루어져야할것이다. V. 결론 본연구는 65세이상여성노인들을대상으로가상현실운동프로그램을 8주간실시한후하지의근활성도와균형능력에미치는영향을분석하여가상현실운동프로그램의효과를알아보았다. 안쪽넓은근, 가쪽넓은근의근활성도 (%MVIC) 값의분석을통하여가상현실운동프로그램이트레드밀을이용한걷기운동프로그램보다하지근활성도를증가하기위해더효과적임을증명하였다. 또한눈을뜨고감은상태에서양발서기를통한총궤적길이의분석을통하여가상현실운동프로그램이트레드밀을이용한걷기운동프로그램보다균형능력을증가하기위해더효과적임을증명하였다. 그러므로가상현실운동프로그램이하지근활성도와균형능력을향상시키는것으로결론을얻었다. Author Contributions Research design: Park SU Acquisition of data: Park SU Analysis and interpretation of data: Lee JH, Kang JI, Yang DJ, Park SK, Park SU Drafting of the manuscript: Park SU Administrative, technical, and material support: Kang JI, Yang DJ, Park SK, Park SU Research supervision: Park SU Acknowledgements 본연구는 2011년대불대학교교내연구비지원을받았음. 참고문헌 1. Ministry. National Health Statistics 2009: National Health and Nutrition Examination Survey 4th 3rd year Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: What does the evidence show? The Medical Clinics of North America. 2006;90(1): Rogers ME, Sherwood HS et al. Effect of dumbbell and elastic training on physical function in order inner-city African-American Women. Women & Health. 2003; 36(4): Effects of Virtual Reality Exercise Program on Muscle Activity and Balance Abilities in Elderly Women

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012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar